title: Funicular myelosis in a butcher: it was the cream cans.
abstract: Background. Funicular myelosis is a known consequence of exposure to nitrous oxide. Nevertheless, there are only a few clinical trials assessing its long-term effects and there is no literature about the role of nutritional vitamin B12 supplementation in the context of nitrous oxide abuse. Case Descriptions. We diagnosed funicular myelosis in a young butcher, who consumed high amounts of meat regularly. Since the diagnostic process did not reveal any metabolic causes, reinterrogation of the patient uncovered recreational abuse of nitrous oxide out of whipped cream can gas cartridges. After stopping abuse and supplementation of vitamin B12, the patient recovered almost completely. Conclusions. In our case, even high nutritional vitamin B12 uptake could not compensate the noxious effects of nitrous oxide. Since there are emerging reports of increasing misuse, this should be considered in the diagnostic and therapeutic care of patients with nitrous oxide abuse. Furthermore, our case emphasizes that patients with vitamin B12 deficiency should be assessed for nitrous oxide abuse.
authors.affiliation: Department of Neurology, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Wolpert
authors.affiliation: Medizinisch Radiologisches Institut (MRI Bethanien), Toblerstrasse 51, Bahnhofplatz, Stadelhofen, 8044 Zürich, Switzerland.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Baráth
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
authors.forename: Janis
authors.initials: J
authors.lastname: Brakowski
authors.affiliation: Department of Neurology, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Renzel
authors.affiliation: Department of Neurology, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Linnebank
authors.affiliation: Department of Neurology, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland ; Neurorehabilitation, RehaClinic, Quellenstrasse 34, 5330 Bad Zurzach, Switzerland.
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Gantenbein