title: Subacute combined degeneration of the spinal cord following recreational nitrous oxide use.
abstract: We describe a case of a young woman who developed myelopathy and peripheral neuropathy following 1 year of recreational nitrous oxide (N2O) use. She presented with uncomfortable tingling sensation in her feet and poor balance. Physical examination revealed mild weakness and hyper-reflexia in the lower limbs. Proprioception and vibration were absent in the lower limbs. Pinprick and light touch sensations were reduced below the sixth thoracic dermatome. A broad-based gait and a positive Romberg sign were noted. The level of vitamin B12 was low (76 pmol/l). T2-weighted MRI scans showed hyperintensity changes at the posterior column from the second to the fifth cervical vertebrae. She made a full recovery following injections of vitamin B12 and physiotherapy. This case discusses subacute combined degeneration of the spinal cord on a background of N2O abuse.
authors.affiliation: Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Hui Mei
authors.initials: HM
authors.lastname: Cheng
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Park
authors.forename: David
authors.initials: D
authors.lastname: Hernstadt
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009609:Nitrous Oxide / Q000506:poisoning*; D026741:Physical Therapy Modalities; D013116:Spinal Cord / Q000473:pathology*; D052879:Subacute Combined Degeneration / Q000139:chemically induced* / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000150:complications*; D014805:Vitamin B 12 / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D009609:Nitrous Oxide; D014805:Vitamin B 12