title: Reversible nitrous oxide-induced myeloneuropathy with pernicious anemia: case report and literature review.
abstract: A previously healthy 27-year-old woman developed a subacute myeloneuropathy after receiving nitrous oxide anesthesia for dental procedures. Neurologic evaluation revealed that she was vitamin B(12) deficient due to underlying pernicious anemia. Discontinuation of nitrous oxide and supplementation with vitamin B(12) resulted in dramatic clinical improvement, with near-complete normalization of her neurologic examination. This case and published reports reviewed here emphasize that favorable outcomes are possible following prompt recognition and treatment of vitamin B(12) deficiency.
authors.affiliation: Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8897, USA. mike.singer@utsouthwestern.edu
authors.forename: Mike A
authors.initials: MA
authors.lastname: Singer
authors.forename: Christos
authors.initials: C
authors.lastname: Lazaridis
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Nations
authors.forename: Gil I
authors.initials: GI
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000752:Anemia, Pernicious / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009413:Nerve Fibers, Myelinated / Q000378:metabolism / Q000473:pathology; D009609:Nitrous Oxide / Q000009:adverse effects*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D013116:Spinal Cord / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000494:pharmacology / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide; D014805:Vitamin B 12