Nitrous oxide myelopathy in an abuser of whipped cream bulbs

A 23 year old man presented with a severe posterior column myelopathy relat ed to prolonged nitrous oxide abuse obtained from whipped cream bulbs. The site of pathology was identified by magnetic resonance imaging (MRI) and so matosensory evoked potentials. The mechanism of toxicity involves inactivat ion of vitamin B-12 dependent enzymes. Appropriate treatment with methionin e and vitamin B-12 was instituted quickly with good neurological outcome. T here are major concerns regarding the availability of nitrous oxide in supe rmarkets. (C) 2000 Harcourt Publishers Ltd.