TY - JOUR T1 - Recreational nitrous oxide-associated neurotoxicity JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 897 LP - 898 DO - 10.1136/jnnp-2017-317768 VL - 89 IS - 8 AU - Kate Johnson AU - Philopatir Mikhail AU - Myong Gyu Kim AU - Annmarie Bosco AU - William Huynh Y1 - 2018/08/01 UR - http://jnnp.bmj.com/content/89/8/897.abstract N2 - A previously healthy 21-year-old woman presented with subacute onset of confusion and gait ataxia. She reported habitual inhalation of nitrous oxide (N2O) purchased online over the past year, with increased consumption over the preceding weeks of up to 300 canisters/week. Examination revealed pale skin with diffuse hyperpigmented macular patches over the trunk (figure 1) and atrophic glossitis. Cognitive impairment was evident with impaired insight, orientation, short-term memory and attention. She had impaired limb proprioception with sensory ataxia and positive Romberg’s test. Distal limb power was significantly reduced with milder weakness proximally and globally depressed reflexes.Figure 1 (A) Hyperpigmented maculopapular rash distributed diffusely over the back and neck. (B) Sagittal and (C) axial T2-weighted images demonstrating hyperintensity in the cervical cord region with an ‘inverted V sign’ classical of subacute combined degeneration of the spinal cord.Laboratory testing demonstrated low … ER -