| Overuse of Nitrous
This 36-year old electrical engineer came to the emergency room complaining that he was unable to walk. Symptoms had begun 4 days earlier with "pins and neeedles" in both feet that gradually worsened and ascended to involve the knees and the fingertips. With worsening of the paresthesias (-no sense of touch or pain-) he noted difficulty in maintaining proper control of the movements of his arms and hands and trouble in walking. He also reported the sensation of electric shocks through his back and legs upon flexion of the neck. He denied bladder or bowel impairment but he had been unable to have an erection for the past week. His past medical history was unremarka- ble except for occasional abuse of alcohol in the past. However he denied any drinking of alcohol for the past 8 months.
For recreational purposes he had inhaled two to three boxes of nitrous oxide, each box containing 24 cartridges, practically every day for the past six months.
When first seen his general physical examination was completely unremarka- ble. The neurological examination showed hyperesthesia and hyperalgesia in the lower extremities up to the knees. He had severe bilateral sensory dystaxia and could only stand with support.
Intramuscular B12 injections were started and during the following days his hematological status inproved, (-apart from neurological symptoms, the functional B12 deficiency caused by N2O also produces megaloblastic anemia,- ed.) although his neurological condition continued to deteriora- te. The paresthesias ascended to the nipples and he developed fecal and urinary incontinence. (- stuff deleted-)
Four weeks later he began to improve and four months after the onset of the symptoms, and his last use of nitrous oxide he could walk with some hesitation and had completely regained bowel and bladder control and sexual function (-stuff deleted-).
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