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Nitrous oxide misuse and vitamin B12 deficiency

Massey, Thomas ORCID:, Pickersgill, Trevor T and Peall, Kathryn J ORCID: 2016. Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Reports , 215728. 10.1136/bcr-2016-215728

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A 36-year-old man presented to hospital with a 5-week history of ascending limb paraesthesiae and balance difficulties. He had no medical or travel history of note, but admitted habitual nitrous oxide (N2O) inhalation. Neurological examination revealed a sensory ataxia with pseudoathetosis in the upper limbs and reduced vibration sensation to the hips bilaterally. Significant investigation results included a low serum vitamin B12 concentration, mild macrocytosis and raised serum homocysteine concentration. T2 MRI of the spinal cord demonstrated increased signal extending from C1 to T11 in keeping with a longitudinal myelitis. The patient was diagnosed with a myeloneuropathy secondary to vitamin B12 deficiency, resulting from heavy N2O inhalation. He was treated with intramuscular vitamin B12 injections and received regular physiotherapy. At discharge, he was able to mobilise short distances with the aid of a zimmer frame, and was independently mobile 8 weeks later.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: BMJ Publishing Group Ltd
ISSN: 1757-790X
Date of First Compliant Deposit: 3 May 2017
Date of Acceptance: 12 May 2016
Last Modified: 07 Nov 2023 17:42

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