B12 related myeloneuropathy secondary to recreational nitrous oxide use: a new neurological emergency

Le résumé fourni par la source

Objectives To investigate the incidence and presentation of B12 related myeloneuropathy secondary to ingestion of recreational Nitrous Oxide. Background Use of nitrous oxide as a legal recreational agent is increasing with relative B12 deficiency a recognised complication. Method Retrospective study of patients referred to same day emergency care neurology service Imperial College NHS trust from January 2021 – December 2022. Inclusion criteria – patients with a suspicion of myeloneuropathy secondary to nitrous oxide use. Results In 17 patients identified (mean age 24.1 years [19 – 35 years]); the reported consumption of nitrous oxide varied but in one case was >20 canisters/day. Patients presented with paraesthesia, weakness and unsteadiness. 6/17 had low B12 level at presentation. 8/17 had normal B12, 3/17 had elevated B12 level as sampling was after replacement. All had a raised homocysteine level and 9/14 had raised methylmalonic acid. 4/16 had cervical dorsal column lesions. Four patients reviewed within 3 months reported substantial improvement but ongoing paraesthesia. Discussion and Recommendations Recreational nitrous oxide use is associated with a myeloneuropathy secondary to functional B12 deficiency. If there is a high clinical suspicion it is recommended to treat with IM B12 replacement whilst awaiting the results of B12 and its metabolites.

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