TY  - JOUR
PY  - 2016//
TI  - An unusual cause of falls in a young woman
JO  - Journal of the Royal College of Physicians of Edinburgh
A1  - Sleeman, I.
A1  - Wiblin, L.
A1  - Burn, D.
SP  - 160
EP  - 162
VL  - 46
IS  - 3
N2  - 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>
LA  - en
SN  - 1478-2715
UR  - http://dx.doi.org/10.4997/JRCPE.2016.304
ID  - ref1
ER  -