@article{ref1,
title="An unusual cause of falls in a young woman",
journal="Journal of the Royal College of Physicians of Edinburgh",
year="2016",
author="Sleeman, I. and Wiblin, L. and Burn, D.",
volume="46",
number="3",
pages="160-162",
abstract="Nitrous oxide is commonly used as an analgesic and anaesthetic agent. Nitrous oxide is also in use in industry as an aerosol propellant and is now recognised as a recreational drug whose use is growing, especially among the young. Nitrous oxide from whipped cream canisters is inhaled to produce a dissociative, intoxicated state. Nitrous oxide is known to inactivate vitamin B12 via oxidation, which can precipitate a demyelinating myelopathy akin to the classical B12 deficiency syndrome, subacute combined degeneration of the spinal cord. This case describes a young woman with chronic pain and a poor nutritional state who took regular nitrous oxide as an opiate-sparing agent. She developed a progressive subacute myelopathy with a sensory level, profoundly impaired joint position sense, extensor plantars and required a wheelchair. Once diagnosed, she responded well to a regime of nitrous oxide withdrawal, high-dose B12 replacement and physiotherapy. The case illustrates the need for clinical teams to be able to dentify a nitrous oxide-precipitated myelopathy as its use as a drug of abuse increases; particularly in the case of malnourished patients who receive nitrous oxide surgically or obstetrically.<p /> <p>Language: en</p>",
language="en",
issn="1478-2715",
doi="10.4997/JRCPE.2016.304",
url="http://dx.doi.org/10.4997/JRCPE.2016.304"
}