Lessons of the month: Nitrous oxide-induced functional vitamin B12 deficiency causing subacute combined degeneration of the spinal cord

被引:7
|
作者
Seed, Adam [1 ]
Jogia, Meesha [2 ]
机构
[1] Southport & Ormskirk Hosp NHS Trust, Southport, Qld, Australia
[2] Warrington & Halton Teaching Hosp NHS Fdn Trust, Warrington, Cheshire, England
关键词
Nitrous oxide; functional vitamin B-12 deficiency; subacute combined degeneration; myelopathy; myeloneuropathy;
D O I
10.7861/clinmed.2020-0072
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We discuss the case of a 22-year-old man who presented with paraesthesia, reduced sensation and weakness in his limbs. Examination was in keeping with a myeloneuropathy. Initial investigations including vitamin B-12 were unremarkable but magnetic resonance imaging of the spinal cord showed subacute combined degeneration. The patient reported heavy recreational use of nitrous oxide, which can cause functional deficiency of vitamin B-12 with neurological sequelae. A diagnosis of functional vitamin B-12 deficiency was made and confirmed by an elevated methylmalonic acid level. The patient received intramuscular hydroxocobalamin and made a good recovery following rehabilitation. Nitrous oxide use is prevalent and can have significant health effects. Many adverse effects are mediated through inactivation of vitamin B-12 and can be detected by elevated homocysteine and methylmalonic acid levels. Early identification and prompt treatment are important to support neurological recovery.
引用
收藏
页码:E7 / E9
页数:3
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