Shariff Mohammed, Abdallah Amr, Salam Abdul, Fathima Samaah
Stroke Medicine department, Russells Hall Hospital, Dudley, West Midlands, United Kingdom.
University of Edinburgh, Old College, South Bridge, Edinburgh, United Kingdom.
Eur J Case Rep Intern Med. 2023 Mar 3;10(3):003765. doi: 10.12890/2023_003765. eCollection 2023.
A previously healthy adolescent male was admitted with paraesthesia of his arms and legs. He admitted to daily recreational nitrous oxide use for the previous 3-4 months. He was found to have severe vitamin B12 deficiency, while magnetic resonance imaging of his spine showed T2 hyperintensity within the dorsal columns. This was suggestive of subacute combined degeneration of the spinal cord. He was treated with intramuscular injections of hydroxocobalamin and showed moderate improvement 1 month post-discharge.
It is important to take a full history of illicit drug use, especially in young patients presenting with unusual symptoms.In cases of suspected nitrous oxide-induced neurological dysfunction with normal vitamin B12 levels, serum levels of methylmalonic acid and homocysteine can be measured to aid diagnosis.Prompt treatment of nitrous oxide-induced subacute combined degeneration of the spinal cord with B12 injections and discontinuation of nitrous oxide use allow for a gradual recovery, although in some cases patients may be left with residual symptoms.
一名既往健康的青少年男性因手臂和腿部感觉异常入院。他承认在过去3 - 4个月中每天吸食笑气用于消遣。他被发现患有严重的维生素B12缺乏症，而其脊柱的磁共振成像显示脊髓后索T2高信号。这提示脊髓亚急性联合变性。他接受了羟钴胺素肌肉注射治疗，出院1个月后有中度改善。
全面了解非法药物使用史很重要，尤其是对于出现异常症状的年轻患者。在怀疑笑气引起的神经功能障碍但维生素B12水平正常的情况下，可测量血清甲基丙二酸和同型半胱氨酸水平以辅助诊断。及时用维生素B12注射治疗笑气引起的脊髓亚急性联合变性并停止使用笑气可使病情逐渐恢复，尽管在某些情况下患者可能会遗留残余症状。
