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Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis

Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myel...

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Autores principales: Gardin, Tova Michal, Yang, Annie, Moeller, Jeremy J, Quraishi, Imran H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689362/
https://www.ncbi.nlm.nih.gov/pubmed/38035681
http://dx.doi.org/10.1136/bcr-2023-254727
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author Gardin, Tova Michal
Yang, Annie
Moeller, Jeremy J
Quraishi, Imran H
author_facet Gardin, Tova Michal
Yang, Annie
Moeller, Jeremy J
Quraishi, Imran H
author_sort Gardin, Tova Michal
collection PubMed
description Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.
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spelling pubmed-106893622023-12-02 Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis Gardin, Tova Michal Yang, Annie Moeller, Jeremy J Quraishi, Imran H BMJ Case Rep Case Reports: Reminder of important clinical lesson Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities. BMJ Publishing Group 2023-11-30 /pmc/articles/PMC10689362/ /pubmed/38035681 http://dx.doi.org/10.1136/bcr-2023-254727 Text en © BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Reports: Reminder of important clinical lesson
Gardin, Tova Michal
Yang, Annie
Moeller, Jeremy J
Quraishi, Imran H
Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title_full Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title_fullStr Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title_full_unstemmed Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title_short Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
title_sort subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis
topic Case Reports: Reminder of important clinical lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689362/
https://www.ncbi.nlm.nih.gov/pubmed/38035681
http://dx.doi.org/10.1136/bcr-2023-254727
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