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Abstract

Nitrous oxide (N₂O) has been increasingly used for recreational purposes due to its dissociative and euphoric properties. Exposure to N₂O results in the deactivation of in vivo vitamin B₁₂, leading to subsequent neurological sequelae due to vitamin B₁₂ deficiency (Hathout & El-Saden, 2011). Current management focuses on cessation of exposure and replacement therapy, yet patients may continue to suffer from permanent neurological damage (Thompson et al., 2015). We report a case of a 50-year-old woman who presented with impaired balance, a subacute decline in mental status, multiple falls, and back pain. She was hospitalized for evaluation of her presenting symptoms and for pain management. The patient’s sister helped uncover the patient’s misuse of N₂O via “Whip-it!” cartridges. Physical examination, along with magnetic resonance imaging of the cervical and thoracic spine, confirmed the diagnosis of subacute combined degeneration (SCD), and appropriate treatment was initiated. Our case aims to bring attention to this seemingly harmless recreational drug that continues to regain popularity and its association with brain and nerve damage (van Amsterdam et al., 2015).

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