Other aspects of nitrous oxide-related neuromyelopathy

The point is well made that the “work-up” of suspected nitrous oxide (NO2) myelopathy should include, not only serum vitamin B12 (i.e., cobalamin) measurement, but also documentation of serum homocysteine, methylmalonic acid (MMA), and folate levels [1]. The rationale is that some patients in whom cobalamin derangements are im plicated in the aetiopathogenesis of NO2-related neurotoxicity may, nevertheless, have serum cobalamin levels within the normal range [2]. In one such patient (case 1) NO2-related neuropathy was initially mistaken for Guillain-Barre syndrome, arguably because there was no concurrent spinal cord demy elination and, hence, no abnormality detected on magnetic resonance imaging (MRI) of the entire spinal cord.

Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research