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Nitrous oxide myelopathy with functional vitamin B 12 deficiency
  1. John Williamson,
  2. Saif Huda and
  3. Dinesh Damodaran
  1. Department of Neurology, The Walton Centre Foundation NHS Trust, Liverpool, UK
  1. Correspondence to Dr John Williamson, john.williamson{at}


Recreational use of nitrous oxide as a ‘legal high’ is increasing in the UK. Physicians should be ‘street wise’ to this increasing prevalence and aware of the potential neurological complications which may result from misuse. We describe a 17-year-old male patient who presented to neurology with a severe myelopathy following prolonged recreational use of nitrous oxide. MRI demonstrated characteristic changes affecting the dorsal columns and blood tests demonstrated a ‘functional’ B12 deficiency. Clinical and radiological improvement was noted following initiation of vitamin B12 replacement.

  • spinal cord
  • vitamins and supplements
  • neurology (drugs and medicines)

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  • Patient consent for publication Obtained.

  • Contributors JW drafted the original manuscript and subsequent revisions. SH and DD critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.