Abstract
Chronic nitrous oxide abuse is a known cause of myeloneuropathy. Nitrous oxide irreversibly
inactivates vitamin B12 causing demyelination of the dorsal spinal columns, clinically
indistinguishable from that which is caused by vitamin B12 deficiency. We report a
37-year-old female who presented with ataxia, loss of lower extremity proprioception,
demyelination of her cervical dorsal spinal columns, and other laboratory and physical
exam findings consistent with nitrous oxide abuse. The patient reported daily use
in excess of 500 nitrous oxide cartridges, also known as “whippits”. Nitrous oxide
myeloneuropathy should be included in the differential diagnoses for emergency medicine
physicians when evaluating a patient with bilateral neurologic deficits and ataxia.
Keywords
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Article Info
Publication History
Published online: January 30, 2021
Accepted:
January 26,
2021
Received in revised form:
January 20,
2021
Received:
October 14,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Inc. All rights reserved.
