Myelopathy nitrous oxide

Myelopathy associated with nitrous oxide abuse has been reported (22). 

A 23-year-old man presented with a 5-day history of gait disturbance and incoordination. He had severe loss of proprioception in his legs and could not walk. He was hypomanic. Severe posterior column myelopathy was diagnosed using MRI scanning. His nitrous oxide use had consisted of 40-60 whipped cream bulbs per day for 6 months. He also admitted to intermittent diamorphine abuse, but not for the 3 weeks before admission. He was treated with hydroxocobalamin and methionine, but still had minor abnormalities 3 months later. 

Two cases of polyneuropathy and myelopathy associated with chronic nitrous oxide abuse have been reported (23,24). 

B. Chronic nitrous oxide abuse may produce megaloblastic anemia, thrombocytopenia, leukopenia, peripheral neuropathy (especially posterior column findings), and myelopathy, similar to the effects of vitamin B,2 deficiency. 

Sotirchos ES, Saidha S, Becker D. Neurological picture. Nitrous oxide-induced myelopathy with inverted V-sign on spinal MRl. J Neurol Neurosurg Psychiatry 2012 83 915-6. 

---