Davda Sunit,  Hussein Akif,  Adams Ashok,  Krishnan Anant,  Roy Amit

Final Pr. ID: Poster #: CR-003

We report the case of a 14 year old male who presented to our Emergency Department with a two week history of worsening neurological
symptoms including decreased subjective sensation, fingertip paraesthesia, and unilateral leg weakness, requiring assitance with stairs. Initial MRI evaluation revealed what appeared to be a longitudinally extensive transverse myelitis centred on the cervical region; however a follow-up MRI one month subsequently (undertaken on account of persistent symptoms) demonstrated long-segment spinal cord swelling and intrinsic signal change apparently confined to the dorsal columnar segments. After correlation with the clinical team, a history of recreational Entonox use for recurrent episodes of chest pain was elicited. With prolonged exposure, the nitrous oxide component of Enotnox can cause inactivation of vitamin B12. Following discussion serum vitamin B12 and folate levels were obtained, demonstrating deficiency in both. Thus in rare cases, Entonox use can lead to subacute combined degeneration of the cord, as demonstrated in our patient.

Recreational Entonox use is on the rise and recognition of its relevance in a history is important as it can be associated with signifcant morbidity, as our case highlights. By utilising a multidisciplinary approach and recognising this rare, yet important diagnosis, we were able to guide patient management. Read More

Authors:  Davda Sunit , Hussein Akif , Adams Ashok , Krishnan Anant , Roy Amit

Keywords:  entonox, sacd, b12