Nitrous oxide myelopathy with functional vitamin B 12 deficiency

Recreational use of nitrous oxide as a 'legal high' is increasing in the UK. Physicians should be 'street wise' to this increasing prevalence and aware of the potential neurological complications which may result from misuse. We describe a 17-year-old male patient who presented to neurology with a severe myelopathy following prolonged recreational use of nitrous oxide. MRI demonstrated characteristic changes affecting the dorsal columns and blood tests demonstrated a 'functional' B₁₂ deficiency. Clinical and radiological improvement was noted following initiation of vitamin B₁₂ replacement.

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