"Whippets"-induced cobalamin deficiency manifesting as cervical myelopathy

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
Alan L DiamondFlorian P Thomas

Abstract

Nitrous oxide (N2O) is inhaled in anesthesia and as a recreational drug from whipped cream dispensers. Its abuse reaches approximately 10% in some age groups. By inactivating cobalamin (Cbl) (vitamin B12), N2O can cause neurologic and hematologic manifestations. We present a case of N2O-induced Cbl deficiency presenting as cervical myelopathy. After regularly inhaling N2O for many months, a 31-year-old man developed limb paresthesiae and ataxia over 3 months. Examination revealed finger pseudoathetosis, hyporeflexia, decreased sensation, and gait ataxia. Brain magnetic resonance imaging (MRI) was normal, but the posterior columns of the cervical and upper thoracic cord revealed patchy nonenhancing hyperintense lesions. Serum Cbl was 98 pg/mL (normal = 170-900 pg/mL). Cbl replacement led to recovery within 3 months. This patient presented with the symptoms and signs of Cbl deficiency. The MRI lesions in the posterior columns aided the diagnosis. Physicians need to have a high level of suspicion in cases of unexplained Cbl deficiency and myelopathy.

Citations

Dec 26, 2013·Psychosomatics·Amir GarakaniDavid M McDowell
Oct 27, 2015·Regulatory Toxicology and Pharmacology : RTP·Jan van AmsterdamWim van den Brink
Sep 10, 2014·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·B Arshi, S Shaw
Mar 6, 2012·Journal of Neurosurgery. Spine·George M GhobrialJames Harrop
Jun 6, 2009·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·William O TatumRyan Murtagh
May 24, 2006·Blood Reviews·S N Wickramasinghe

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