Recreational Nitrous Oxide-Induced Subacute Combined Degeneration

Yetunde B Omotosho, Grace W Ying, Richard Orji, Heeren Patel, Yetunde B Omotosho, Grace W Ying, Richard Orji, Heeren Patel

Abstract

Subacute combined degeneration (SCD) is myelopathy caused by vitamin B12 deficiency, leading to demyelination of the dorsal column located in the posterior spinal cord. Despite the high prevalence of recreational nitrous oxide use, its detrimental effects, including significant nerve dysfunction, are insufficiently recognized. We present the case of a 32-year-old male who was brought to the emergency department with complaints of paresthesia of his four extremities and lower extremity weakness. He was found to have B12 deficiency from chronic nitrous oxide abuse and responded positively to intramuscular B12 supplementation. It is important to consider possible nitrous oxide abuse while investigating suspected B12 deficiency, especially in patients presenting with nonspecific myeloneuropathy. Elevated methylmalonic acid (MMA) level is specific for diagnosing B12 deficiency. Prompt diagnosis and treatment can lead to the resolution of the symptoms and prevent further nerve damage.

Keywords: methylmalonic acid; nitrous oxide abuse; nitrous oxide myelopathy; rare cause of vitamin b12 deficiency; subacute combined degeneration of the spinal cord.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Omotosho et al.

Figures

Figure 1. MRI axial cervical spine showing…
Figure 1. MRI axial cervical spine showing the “inverted V sign” (red arrow), consistent with SCD of the cord.
MRI: Magnetic Resonance Imaging; SCD: Subacute Combined Degeneration.

References

    1. Advances in understanding the actions of nitrous oxide. Emmanouil DE, Quock RM. Anesth Prog. 2007;54:9–18.
    1. The incidence of postoperative atelectasis in the dependent lung following thoracotomy: the value of added nitrogen. Browne DR, Rochford J, O'Connell U, Jones JG. Br J Anaesth. 1970;42:340–346.
    1. Ankar A, Kumar A. StatPearls Publishing. Treasure Island, FL: StatPearls Publishing; 2022. Vitamin B12 Deficiency.
    1. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. Hemmer B, Glocker FX, Schumacher M, Deuschl G, Lücking CH. J Neurol Neurosurg Psychiatry. 1998;65:822–827.
    1. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Devalia V, Hamilton MS, Molloy AM. Br J Haematol. 2014;166:496–513.
    1. Three-point sign in subacute combined degeneration of the spinal cord: a case report. Zhang HN, Wang L, Sun L, Yang Y. Medicine (Baltimore) 2018;97:0.
    1. Teaching neuroImage: inverted V sign in subacute combined degeneration of spinal cord. Kumar A, Singh AK. Neurology. 2009;72:0.
    1. Case 87: subacute combined degeneration. Naidich MJ, Ho SU. Radiology. 2005;237:101–105.
    1. Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users. Winstock AR, Ferris JA. J Psychopharmacol. 2020;34:229–236.
    1. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Garakani A, Jaffe RJ, Savla D, Welch AK, Protin CA, Bryson EO, McDowell DM. Am J Addict. 2016;25:358–369.

Source: PubMed

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