A case of unusual substance abuse causing myeloneuropathy

Shulman, Ryan; Geraghty, Timothy; Tadros, Micheal

doi:10.1038/sj.sc.3101962

Cited by 31 publications

(28 citation statements)

References 11 publications

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“…[1][2][3][4][5][6][7][8][9]. The appeal of these reports seems to be that this association, between nitrous oxide exposure and B 12 deficiency myelopathy, comes as a novel and surprising fact to many physicians.…”

Section: Introductionmentioning

confidence: 95%

Nitrous oxide-induced B12 deficiency myelopathy: Perspectives on the clinical biochemistry of vitamin B12

Hathout

El‐Saden

2011

Journal of the Neurological Sciences

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Section: Introductionmentioning

confidence: 95%

Nitrous oxide-induced B12 deficiency myelopathy: Perspectives on the clinical biochemistry of vitamin B12

Hathout

El‐Saden

2011

Journal of the Neurological Sciences

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“…In these cases vitamin B12 deficiencies were due to pernicious anemia [14][15][16], intestinal malabsorption [17], poor diet [18][19][20], drugs [21], and nitrous oxide abuse [22]. Arterial and venous thrombotic events have been demonstrated including recurrent thrombosis [16,20] and unexpected sites of thromboses such as sinus venous thrombosis [14,17,20], spleen and kidney infarction [14], or portal venous thrombosis [23].…”

Section: Introductionmentioning

confidence: 98%

Vitamin B12 deficiency, hyperhomocysteinemia and thrombosis: a case and control study

et al. 2011

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This study aimed at assessing the relationship between thrombosis, hyperhomocysteinemia and vitamin B12 deficiency using a case-control study carried out in 326 patients with thrombosis (case group) and 351 patients from the same hospital (control group). Apart from the classic risk factors, a number of hematological variables were evaluated, including serum vitamin B12 (B12), red cell folate (RCF), and serum homocysteine (Hcy). An evaluation of serum methylmalonic acid (MMA) and a clinical study were carried out to investigate B12 pathology. Results of univariate analysis demonstrated decreased B12 levels in thrombosis (Student's t test, p < 0.0001). Vitamin B12 below 200 pmol/l (LB200) or below 150 pmol/l (LB150), and red cell folate below 600 nmol/l were found in 17.2, 8.6, and 2.2% of cases with thromboembolism, respectively. An increase in Hcy was detected in 86 cases with thrombosis (26.3%). An abnormality in vitamin B12 and/or renal function was found in 80% of cases with hyperHcy and thrombosis. The MMA increase demonstrated that vitamin B12 deficiency was present in these patients with low levels of vitamin B12 in serum, and the MMA levels were in concordance with Hcy levels. The clinical study revealed B12 malabsorption in most cases with LB200. Multivariate analysis showed that serum vitamin B12 (RR 0.998, CI 0.997-0.999) was moderately related to thromboembolism. The results indicated that vitamin B12 deficiency was common among patients with hyperhomocysteinemia and thrombosis. Moreover, HyperHcy was caused by vitamin B12 deficiency and/or chronic renal failure in most patients with thrombosis. As the main cause of vitamin B12 deficiency was vitamin malabsorption, parenteral vitamin B12 with or without folic acid should be administered for the treatment of this condition. However, it remains to be demonstrated whether this treatment approach prevents recurrent thromboses in patients with vitamin B12 deficiency and thrombosis, as suggested by some case reports.

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“…T2-weighted MRI images of the spinal cords of patients with chronic nitrous oxideinduced myelopathy have shown increased uptake in the posterior columns (3)(4)(5)(6). Our patient had normal brain and cervical spine MRIs; however, he demonstrated signs and symptoms of a marked myeloneuropathy in the setting of short-term, high-dose nitrous oxide abuse.…”

Section: Discussionmentioning

confidence: 71%

“…These reports describe months of constant nitrous oxide abuse before the onset of neurologic symptoms (3,4,6). Goldfrank's Toxicologic Emergencies also describes the neurologic changes associated with nitrous oxide as occurring only after months of frequent exposure (7).…”

Section: Discussionmentioning

confidence: 97%

“…A quick search of the internet reveals multiple websites with instructions on where to buy nitrous oxide and techniques for inhalation. Previous case reports describe chronic nitrous oxide exposure leading to myeloneuropathy and other symptoms of B 12 deficiency (3)(4)(5)(6). It is important for clinicians to recognize the potential effects of nitrous oxide abuse to begin treatment as early as possible.…”

Section: Introductionmentioning

confidence: 97%

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