Nitrous oxide myelopathy posing as spinal cord injury

Case report

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  • Departments of Neurological Surgery and Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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The authors describe a patient who presented with acute tetraparesis and a proposed acute traumatic spinal cord injury that was the result of nitrous oxide myelopathy. This 19-year-old man sustained a traumatic fall off a 6-ft high wall. His examination was consistent with a central cord syndrome with the addition of dorsal column impairment. Cervical MRI demonstrated an isolated dorsal column signal that was suggestive of a nontraumatic etiology. The patient's symptoms resolved entirely over the course of 48 hours.

Nitrous oxide abuse is increasing in prevalence. Its toxic side effects can mask vitamin B12 and folate deficiency and central cord syndrome. The patient's history and radiographic presentation are key to establishing a diagnosis.

Abbreviations used in this paper:NASCIS II = Second National Acute Spinal Cord Injury Study; SCI = spinal cord injury.

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Contributor Notes

Address correspondence to: James Harrop, M.D., Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, Pennsylvania 19107. email: james.harrop@jefferson.edu.

Please include this information when citing this paper: published online March 2, 2012; DOI: 10.3171/2012.2.SPINE11532.

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