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Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter
Nitrous oxide (N(2)O) has several traditional uses as a surgical and dental anaesthetic, as well as in aerosol spray propellants. It is the combination of analgesic and euphoric qualities coupled with accessibility as an over-the-counter household item that lends N(2)O to recreational use. Despite i...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Institute of Radiology.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171132/ https://www.ncbi.nlm.nih.gov/pubmed/34131499 http://dx.doi.org/10.1259/bjrcr.20200179 |
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author | Charters, Pia F P Morrison, Hamish Duncan Witherick, Jonathan King, Susan |
author_facet | Charters, Pia F P Morrison, Hamish Duncan Witherick, Jonathan King, Susan |
author_sort | Charters, Pia F P |
collection | PubMed |
description | Nitrous oxide (N(2)O) has several traditional uses as a surgical and dental anaesthetic, as well as in aerosol spray propellants. It is the combination of analgesic and euphoric qualities coupled with accessibility as an over-the-counter household item that lends N(2)O to recreational use. Despite increasing evidence that prolonged use of N(2)O both medically and as a drug of abuse can cause disabling neurological side-effects, it remains widely used. We present the case of an 18-year-old male who was diagnosed with subacute combined degeneration of the cord (SCDC) secondary to acute, heavy recreational use of N(2)O. The patient presented with progressive paraesthesia affecting his hands and feet associated with distal weakness. MRI of the cervical spine revealed symmetric bilateral high T2 signal within the dorsal columns extending from the level of C2 to T2 with the inverted ‘V’ sign on axial T(2)-weighted slices indicative of SCDC. Although vitamin B12 levels were within normal range, marked elevation of methylmalonic acid and homocysteine support the diagnosis of B12 inactivation and functional B12 deficiency, which fully resolved with treatment. |
format | Online Article Text |
id | pubmed-8171132 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | The British Institute of Radiology. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81711322021-06-14 Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter Charters, Pia F P Morrison, Hamish Duncan Witherick, Jonathan King, Susan BJR Case Rep Case Report Nitrous oxide (N(2)O) has several traditional uses as a surgical and dental anaesthetic, as well as in aerosol spray propellants. It is the combination of analgesic and euphoric qualities coupled with accessibility as an over-the-counter household item that lends N(2)O to recreational use. Despite increasing evidence that prolonged use of N(2)O both medically and as a drug of abuse can cause disabling neurological side-effects, it remains widely used. We present the case of an 18-year-old male who was diagnosed with subacute combined degeneration of the cord (SCDC) secondary to acute, heavy recreational use of N(2)O. The patient presented with progressive paraesthesia affecting his hands and feet associated with distal weakness. MRI of the cervical spine revealed symmetric bilateral high T2 signal within the dorsal columns extending from the level of C2 to T2 with the inverted ‘V’ sign on axial T(2)-weighted slices indicative of SCDC. Although vitamin B12 levels were within normal range, marked elevation of methylmalonic acid and homocysteine support the diagnosis of B12 inactivation and functional B12 deficiency, which fully resolved with treatment. The British Institute of Radiology. 2021-02-05 /pmc/articles/PMC8171132/ /pubmed/34131499 http://dx.doi.org/10.1259/bjrcr.20200179 Text en © 2021 The Authors. Published by the British Institute of Radiology https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Case Report Charters, Pia F P Morrison, Hamish Duncan Witherick, Jonathan King, Susan Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title | Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title_full | Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title_fullStr | Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title_full_unstemmed | Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title_short | Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter |
title_sort | subacute combined degeneration of the cord secondary to nitrous oxide misuse: no laughing matter |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171132/ https://www.ncbi.nlm.nih.gov/pubmed/34131499 http://dx.doi.org/10.1259/bjrcr.20200179 |
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