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Myelopathy: 2 case reports. A 30-year-old man and a 28-year-old man developed myelopathy during treatment with nitrous oxide [not all routes, dosages and indications stated]. Case 1: The man was hospitalised with progressive motor deficit of the bilateral extremities, paresthesia, bladder impairment, inability to walk and fecal incontinence after 4 hours use of nitrous oxide inhalation within 6 days. Clinical evaluation revealed tetraparesis with distal predominance, a sensory deficit up to T3-T4 level, proprioceptive loss, Lhermitte’s sign and anal sphincter hypotonia. MRI of spinal cord revealed abnormal T2-weighted hyperintensity in the posterior region at C3-C5 levels, with no contrast enhancement. His cobalamin [vitamin-B12] was 131 pmol/dL and other investigations were unremarkable. Urine analysis showed benzodiazepine. He was consider to have myelopathy. He was started on treatment with unspecified corticosteroids and high doses of cobalamin. Subsequently, his clinical condition improved but had permanent sequelae at 12 months. Case 2: The man was on nitrous oxide nitrous oxide; 3-4 capsules daily since 4 days under cannabis withdrawal context. He developed anxiety, Lhermitte’s sign and distal paresthesias of upper bilateral extremities. His MRI of the spinal cord revealed hyperintensity in T2 in the posterior region of C5-C7. His other examinations were unremarkable. He was consider to have myelopathy. He rapidly improved after high doses of cobalamin. Elena V-G, et al. Myelopathy after nitrous oxide inhalation. European Journal of Neurology 27 (Suppl. 1): 358-359 (plus poster) abstr. EPR2160, May 2020. Available from: 803498447 URL: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.14307 [abstract]

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Reactions 29 Aug 2020 No. 1819