Disclosures: Jordan A. Feierman, DO: Nothing to disclose

Case Description: The patient admitted to a history of nitrous oxide abuse by inhalation of whipped cream canisters. Physical exam demonstrated both cerebellar and posterior column dysfunction. Diagnostics revealed normal Vitamin B12 and folate levels with elevated levels of methylmalonic Acid (MMA) and homocysteine and magnetic resonance imaging (MRI) of the brain, cervical spine, and thoracic spine showed dorsal column signal hyperintensities. These findings were believed to be the result of a functional Vitamin B12 deficiency secondary to nitrous oxide abuse. The patient was treated with intramuscular Vitamin B12 supplementation with 1000 mcg/day for 7 days with aggressive physical therapy. The patient was subsequently transitioned to an oral Vitamin B12 regimen upon discharge with home physical therapy. She was counseled and advised on complete cessation of nitrous oxide inhalation.

Setting: Acute hospital

Patient: A 36-year-old female presented with a 3-day history of worsening numbness of her lower extremities as well as ataxia contributing to multiple falls.

Assessment/Results: The patient subsequently made vast improvements on serial neurologic exams with dysmetria as well as dysdiadokokinesia. In addition, her sensory deficits, hyperreflexia, and gait ataxia all resolved.

Discussion: There have been few reported cases of nitrous oxide abuse resulting in neurotoxicity secondary to a functional Vitamin B12 deficiency and subacute combined degeneration.

Conclusion: Nitrous oxide toxicity is uncommon, but the neurological manifestations are significant and may be severely debilitating.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nitrous-oxide-toxicity-in-a-young-female-resulting-in-lower-extremity-paresthesias-and-severe-gait-ataxia-a-case-report/