Nitrous oxide, also known as ‘laughing gas’, is one of the most widely used recreational drugs among teenagers in the UK. Copious inhalation of nitrous oxide may increase intra-alveolar pressure, resulting in barotrauma secondary to alveolar rupture. Pneumomediastinum and subcutaneous emphysema are common clinical findings in nitrous oxide-associated barotrauma. Prolonged nitrous oxide misuse may inactivate vitamin B12 through the alteration of its metabolism, causing demyelination of the central and peripheral nervous system. A spectrum of neurological manifestations has been reported, including peripheral neuropathy, myelopathy and subacute combined degeneration of the spinal cord. Medical therapies and psychosocial interventions aiming at nitrous oxide cessation are important treatment steps to achieve partial or complete recovery from the adverse effects associated with inhalation of nitrous oxide.
Ulnar-sided wrist pain is a complex entity to diagnose clinically and frequently requires imaging to help confirm or determine the diagnosis. This article reviews the imaging and the logical imaging pathway of the common causes of ulnar-sided wrist pain, and illustrates various pathologies. It also discusses appropriate imaging modalities for various conditions. The causes of ulnar-sided wrist pain are stratified according to the affected anatomical structures, such as bony, soft tissue or neurovascular aetiologies. This review provides a handy imaging framework for non-radiologist clinicians of the common conditions producing ulnar-sided wrist pain. A linked article ( 10.12968/hmed.2019.80.8.456 ) detailing the diagnosis of ulnar-sided wrist pain is included in this issue.
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