Barmak Fahim, Numan Jamil, Shabih Mariam, Nolte Justin, Adams Jason, Ferguson Paul, Inam Syed Hashim A
Neurology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2024 Nov 16;16(11):e73807. doi: 10.7759/cureus.73807. eCollection 2024 Nov.
Whippets abuse, prevalent among recreational drug users, poses significant health risks, particularly through the inactivation of vitamin B12 by nitrous oxide (NO). This deficiency can lead to myelopathy, resulting in serious neurological complications. We present two female patients, aged 22 and 35, with a history of regular whippet use over the past three years, who exhibited clinical symptoms of myelopathy, including motor weakness, rigidity, sensory changes, and gait abnormalities. The 35-year-old patient showed weakness and swelling in her legs; magnetic resonance imaging (MRI) revealed no acute findings, but lab results indicated a critically low serum vitamin B12 level (102 pg/mL), elevated homocysteine (44 µmol/L), and high methylmalonic acid (29,054 nmol/L). She improved with vitamin B12, vitamin D supplementation, and physical and occupational therapy. The 22-year-old patient reported progressive stiffness and tingling, with MRI revealing T2 hyperintensities in the brain and longitudinal T2 hyperintensities in the posterior spinal cord; her vitamin B12 level was 180 pg/mL, and she responded positively to supplementation and physical therapy. These cases underscore the risk of nitrous oxide-induced myelopathy associated with vitamin B12 deficiency among whippet users. Early recognition and intervention are essential to prevent irreversible neurological damage, and routine screening for vitamin B12 deficiency in this population is recommended. Further research is needed to explore the long-term implications of NO abuse.
ippets滥用在娱乐性吸毒者中很普遍，会带来重大健康风险，尤其是通过一氧化二氮（NO）使维生素B12失活。这种缺乏会导致脊髓病，引发严重的神经并发症。我们介绍两名女性患者，年龄分别为22岁和35岁，在过去三年中有定期使用ippets的历史，她们表现出脊髓病的临床症状，包括运动无力、僵硬、感觉变化和步态异常。35岁的患者腿部出现无力和肿胀；磁共振成像（MRI）未发现急性病变，但实验室结果显示血清维生素B12水平极低（102 pg/mL）、同型半胱氨酸升高（44 µmol/L）和甲基丙二酸水平高（29,054 nmol/L）。她通过补充维生素B12、维生素D以及物理和职业治疗后病情有所改善。22岁的患者报告有进行性僵硬和刺痛感，MRI显示脑部T2高信号以及脊髓后部纵向T2高信号；她的维生素B12水平为180 pg/mL，补充维生素和物理治疗后反应良好。这些病例强调了ippets使用者中与维生素B12缺乏相关的一氧化二氮诱导脊髓病的风险。早期识别和干预对于预防不可逆的神经损伤至关重要，建议对该人群进行维生素B12缺乏的常规筛查。需要进一步研究来探索一氧化二氮滥用的长期影响。
