title: [Vitamin B12 deficiency due to nitrous oxide use: unrecognized cause of combined spinal cord degeneration].
abstract: BACKGROUND
  Nitrous oxide is widely used in anesthesia. It is usually safe but may be associated with severe side effects when it is used repeatedly or on a prolonged time. Here, we report a case of drug-induced subacute combined spinal cord degeneration related to cobalamin deficiency.
  
  
  METHODS
  A 20-year-old man with sickle-cell disease (SS) who was followed for severe recurrent vaso-occlusive crisis with repeated hospital admissions presented with ascending motor and sensitive neurological deficits that were later associated with bladder dysfunction. He was first considered to develop Guillain-Barre syndrome. However, persisting neurological signs despite adequate treatment lately led to diagnose subacute combined medullar degeneration due to abnormal cobalamin (vitamin B12) metabolism induced by repeated use of nitrous oxide during painful episodes of sickle-cell disease.
  
  
  CONCLUSIONS
  Inhaled nitric oxide is widely used in the treatment of vaso-occlusive crisis. Clinicians should be aware of possible severe neurologic side effects.
authors.affiliation: Service de médecine interne, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France. Electronic address: clairechaugny@gmx.fr.
authors.forename: C
authors.initials: C
authors.lastname: Chaugny
authors.affiliation: Service de médecine interne, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: J
authors.initials: J
authors.lastname: Simon
authors.affiliation: Service de médecine interne, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: H
authors.initials: H
authors.lastname: Collin-Masson
authors.affiliation: Unité mobile douleur-soins palliatifs, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: M
authors.initials: M
authors.lastname: De Beauchêne
authors.affiliation: Service d'imagerie médicale, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: D
authors.initials: D
authors.lastname: Cabral
authors.affiliation: Service de neurologie, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: O
authors.initials: O
authors.lastname: Fagniez
authors.affiliation: Service de médecine interne, centre hospitalier Poissy-St-Germain, 20, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: C
authors.initials: C
authors.lastname: Veyssier-Belot
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis; D006801:Humans; D008297:Male; D009410:Nerve Degeneration / Q000139:chemically induced* / Q000175:diagnosis; D009609:Nitrous Oxide / Q000009:adverse effects*; D010146:Pain / Q000188:drug therapy; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000175:diagnosis; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D009609:Nitrous Oxide
keywords: Drépanocytose; Myelitis; Myélite; Nitrous oxide; Protoxyde d’azote; Sickle-cell disease; Vitamin B12; Vitamine B12