A case of unusual substance abuse causing myeloneuropathy

Study design: Case report. Objectives: Examine an unusual drug related case of myeloneuropathy as well as the pathophysiology of nitrous oxide induced subacute combined degeneration. Setting: Major metropolitan teaching hospital - Princess Alexandra Hospital, Queensland, Australia. Methods: Review case notes, investigations, relevant medical literature and epidemiological data. Results: A 23-year-old female developed a myeloneuropathy and encephalopathy after an 8-month history of nitrous oxide abuse. Her presentation was complicated by acute renal failure, deep vein thrombosis ( DVT) and pulmonary embolism ( PE) as well as severe cognitive deficits. After eight months of multidisciplinary rehabilitation the patient is able to walk short distances with mobility aids and is able to manage self cares. However, she still requires a wheelchair for long distances and will have significant residual neurological deficits. Conclusion: The abuse of nitrous oxide has potentially serious outcomes that require discussion of issues related to harm minimisation and health promotion.