A surge in recreational nitrous oxide misuse has prompted new guidelines to be published and adopted with the aim of helping clinicians recognise cases and prevent spinal cord damage.
The mechanism by which nitrous oxide causes subacute combined degeneration involves nitrous oxide-induced inactivation of vitamin Band inhibition of methionine synthetase, disrupting methylation and DNA synthesis, and leading to injury of the neuronal axons. Demonstrating a "pattern of myeloneuropathy usually associated with severe vitamin Bdeficiency", it commonly presents with sensory deficits, distal paraesthesia, weakness, ataxia, and gait disturbance.
"Patients often do not mention nitrous oxide use, possibly because they do not connect it with their symptoms or because they feel there is stigma associated with disclosing its use," highlighted the authors. They suggested that clinicians shouldbe aware of the prevalence of nitrous oxide abuse in their local area and make "careful enquiries" to determine whether nitrous oxide abuse might be causing the symptoms.
Professor Alastair Noyce, consultant neurologist at Queen Mary, and senior author, pointed out. He expressed hope that "if implemented correctly" the guidelines will ensure patients get the treatment they need, and by improving efficiency in the emergency department, and reducing unnecessary admissions, pressure on hospitals will be alleviated.
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