title: Myeloneuropathy following nitrous oxide anesthaesia in a patient with macrocytic anaemia.
abstract: The neurological condition triggered by anaesthesia with nitrous oxide involves the cyanocobalamine pathway and is characterised by progressive demyelination and axonal lesions of the peripheral nerves and cervicothoracic spinal cord (posterior and anterolateral columns) giving a peripheral neuropathy and very frequently subacute combined degeneration of the spinal cord. It is possible to show these demyelinating lesions by MRI of the spine, allowing early diagnosis and follow-up. We describe a case of myeloneuropathy with onset a few hours after nitrous oxide anaesthesia in a patient with macrocytic anaemia and possible subclinical vitamin B(12) deficiency and MRI evidence of a lesion of the cervical spinal cord. Neurological and haematological improvement followed cyanocobalamine replacement.
authors.affiliation: Department of Neurology, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, Brazil.
authors.forename: R M
authors.initials: RM
authors.lastname: Sesso
authors.forename: Y
authors.initials: Y
authors.lastname: Iunes
authors.forename: A C
authors.initials: AC
authors.lastname: Melo
mesh_terms: D000748:Anemia, Macrocytic / Q000150:complications*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009609:Nitrous Oxide / Q000009:adverse effects*; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D014806:Vitamin B 12 Deficiency
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide