Nitrous oxide myelopathy in an abuser of whipped cream bulbs.
A 23 year old man presented with a severe posterior column myelopathy related to prolonged nitrous oxide abuse obtained from whipped cream bulbs. The site of pathology was identified by magnetic resonance imaging (MRI) and somatosensory evoked potentials. The mechanism of toxicity involves inactivation of vitamin B12 dependent enzymes. Appropriate treatment with methionine and vitamin B12 was instituted quickly with good neurological outcome. There are major concerns regarding the availability of nitrous oxide in supermarkets.
Butzkueven
H
H
Neurology Registrar, The Royal Melbourne Hospital, Victoria, Australia. helmutb@ozemail.com.au
King
J O
JO
D000328:Adult; D002574:Cervical Vertebrae; D006801:Humans; D008297:Male; D008715:Methionine / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000009:adverse effects*; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000150:complications*; D014805:Vitamin B 12 / Q000627:therapeutic use
D008715:Methionine; D009609:Nitrous Oxide; D014805:Vitamin B 12