“Whippets”-induced vitamin B12 deficiency and dorsal column degeneration

Case Summary

A 32 year old pregnant woman at 11^th week gestation presented with 2 weeks of progressive gait difficulty and ascending weakness. Patient admitted to recreational inhalation of nitrous oxide from whipped-cream bulbs “whippets”. On examination, she had mild weakness in her extremities. Laboratory examination was significant for a low serum cobalamin (vitamin B12) level. Furthermore, homocysteine and methylmalonic acid were elevated. Parietal cell and intrinsic factor antibodies were negative. She was started on vitamin B12 injections and transferred to an acute rehabilitation facility.

Legend

A sagittal T2-weighted magnetic resonance imaging (MRI) scan (Panel A) demonstrated increased signal in the dorsal columns spanning the C2-C6 levels (arrow). An axial T2-weighted MRI scan (Panel B) further illustrated the increased signal within the dorsal columns (arrow).

Disclosures

Dr. Mocco received research support from ev3; has served as a consultant to Concentric and Actelion; serves on the advisory board of Lazarus Effect, Edge Therapeutics, and NFocus; and has ownership in Codman Neurovascular. The rest of the authors have no disclosures.