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Rationale: In recent years, recreational use of inhaled nitrous oxide (N 2 O) is on the increase among young people, accompanied by a corresponding rise in reports about its toxicity. Subacute combined degeneration of the spine cord (SCD) is the typical clinical picture of the nervous system disorder caused by N 2 O intoxication, as a result of metabolic disturbance of vitamin B12. Patient concerns, diagnoses, interventions and outcomes: We report a 28-year-old female of SCD due to prolonged use of N 2 O, presented with paresthesia and unsteady in walking progressing within 1 month. Symptoms gradually improved with the treatment of intramuscular injections of hydroxocobalamin combined with N 2 O abstinence, and the patient recovered completely with normal neurological examination after 4 months of follow-up. Lessons: Clinicians should be aware of the clinical features and pathogenesis of SCD caused by N 2 O intoxication in order to lead effective treatment as soon as possible. Recreational N 2 O use should always be considered as an etiology when dealing with patients presented with myelopathy and/or neuropathy suspected of vitamin B12 deficiency.
Wang et al. (Fri,) studied this question.