title: A case of unusual substance abuse causing myeloneuropathy.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  Examine an unusual drug related case of myeloneuropathy as well as the pathophysiology of nitrous oxide induced subacute combined degeneration.
  
  
  METHODS
  Major metropolitan teaching hospital - Princess Alexandra Hospital, Queensland, Australia.
  
  
  METHODS
  Review case notes, investigations, relevant medical literature and epidemiological data.
  
  
  RESULTS
  A 23-year-old female developed a myeloneuropathy and encephalopathy after an 8-month history of nitrous oxide abuse. Her presentation was complicated by acute renal failure, deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as severe cognitive deficits. After eight months of multidisciplinary rehabilitation the patient is able to walk short distances with mobility aids and is able to manage self cares. However, she still requires a wheelchair for long distances and will have significant residual neurological deficits.
  
  
  CONCLUSIONS
  The abuse of nitrous oxide has potentially serious outcomes that require discussion of issues related to harm minimisation and health promotion.
authors.affiliation: Spinal Injuries Unit, Princess Alexandra Hospital, Qld, Australia.
authors.forename: R M
authors.initials: RM
authors.lastname: Shulman
authors.forename: T J
authors.initials: TJ
authors.lastname: Geraghty
authors.forename: M
authors.initials: M
authors.lastname: Tadros
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009609:Nitrous Oxide / Q000633:toxicity*; D052879:Subacute Combined Degeneration / Q000139:chemically induced* / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000150:complications*; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000209:etiology
chemical_list: D009609:Nitrous Oxide