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- Brian Lewis, Gilbert Nelson, Thomas Vu, and Bryan Judge.
- Spectrum Health, 100 Michigan St SE, Grand Rapids, MI 49503, United States of America. Electronic address: brian.lewis1@spectrumhealth.org.
- Am J Emerg Med. 2021 Aug 1; 46: 799.e1-799.e2.
AbstractChronic nitrous oxide abuse is a known cause of myeloneuropathy. Nitrous oxide irreversibly inactivates vitamin B12 causing demyelination of the dorsal spinal columns, clinically indistinguishable from that which is caused by vitamin B12 deficiency. We report a 37-year-old female who presented with ataxia, loss of lower extremity proprioception, demyelination of her cervical dorsal spinal columns, and other laboratory and physical exam findings consistent with nitrous oxide abuse. The patient reported daily use in excess of 500 nitrous oxide cartridges, also known as "whippits". Nitrous oxide myeloneuropathy should be included in the differential diagnoses for emergency medicine physicians when evaluating a patient with bilateral neurologic deficits and ataxia.Copyright © 2021 Elsevier Inc. All rights reserved.
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