Seed Adam, Jogia Meesha
Southport and Ormskirk Hospital NHS Trust, Southport, UK
Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK.
Clin Med (Lond). 2020 May;20(3):e7-e9. doi: 10.7861/clinmed.2020-0072.
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 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 with neurological sequelae. A diagnosis of functional vitamin B 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 and can be detected by elevated homocysteine and methylmalonic acid levels. Early identification and prompt treatment are important to support neurological recovery.
我们讨论了一名22岁男性的病例，该患者出现肢体感觉异常、感觉减退和无力。检查结果符合脊髓神经病。包括维生素B在内的初步检查无异常，但脊髓磁共振成像显示亚急性联合变性。患者报告大量娱乐性使用一氧化二氮，这可导致维生素B功能缺乏并伴有神经后遗症。诊断为功能性维生素B缺乏，并通过甲基丙二酸水平升高得到证实。患者接受了肌肉注射羟钴胺素治疗，康复后恢复良好。一氧化二氮的使用很普遍，并且会对健康产生重大影响。许多不良反应是通过维生素B失活介导的，可通过同型半胱氨酸和甲基丙二酸水平升高检测到。早期识别和及时治疗对于支持神经恢复很重要。
