An unusual cause of falls in a young woman

I Sleeman*, L Wiblin, D Burn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Nitrous oxide is commonly used as an analgesic and anaesthetic agent. Nitrous oxide is also in use in industry as an aerosol propellant and is now recognised as a recreational drug whose use is growing, especially among the young. Nitrous oxide from whipped cream canisters is inhaled to produce a dissociative, intoxicated state. Nitrous oxide is known to inactivate vitamin B12 via oxidation, which can precipitate a demyelinating myelopathy akin to the classical B12 deficiency syndrome, subacute combined degeneration of the spinal cord. This case describes a young woman with chronic pain and a poor nutritional state who took regular nitrous oxide as an opiate-sparing agent. She developed a progressive subacute myelopathy with a sensory level, profoundly impaired joint position sense, extensor plantars and required a wheelchair. Once diagnosed, she responded well to a regime of nitrous oxide withdrawal, high-dose B12 replacement and physiotherapy. The case illustrates the need for clinical teams to be able to dentify a nitrous oxide-precipitated myelopathy as its use as a drug of abuse increases; particularly in the case of malnourished patients who receive nitrous oxide surgically or obstetrically.

Original languageEnglish
Pages (from-to)160-162
Number of pages3
JournalThe journal of the Royal College of Physicians of Edinburgh
Issue number3
Publication statusPublished - 27 Sept 2016

Bibliographical note

We would like to thank the patient for her permission to publish the case study.


  • myelopathy
  • nitrous oxide
  • post-anaesthetic complication
  • recreational drugs


Dive into the research topics of 'An unusual cause of falls in a young woman'. Together they form a unique fingerprint.

Cite this