Nitrous Oxide/Whippits-Induced Thoracic Spinal Cord Myelopathy and Cognitive Decline With Normal Serum Vitamin B₁₂

Cureus, 2022 · DOI: 10.7759/cureus.24581 · Published: April 29, 2022

Simple Explanation

Nitrous oxide, commonly inhaled from whipped cream canisters (whippits), can lead to severe vitamin B12 deficiency and neurological damage. This case reports a patient with thoracic cord myelopathy from whippit abuse, despite normal serum vitamin B12 levels, highlighting the need for better diagnostic markers like methylmalonic acid (MMA). The patient's persistent neurological deficits despite vitamin B12 supplementation underscore the irreversible damage and the public health threat posed by unregulated whippit sales.

Study Duration

3 months

Participants

One 44-year-old male

Evidence Level

Case Report

Key Findings

1
The patient presented with sub-acute onset upper and lower extremity rigidity and memory loss due to whippit abuse.
2
MRI of the thoracic spinal cord revealed significant and diffuse increased T2 signal abnormalities throughout the central portion of the spinal cord.
3
Elevated homocysteine and MMA levels were observed despite normal serum vitamin B12, suggesting improved biomarkers are needed for diagnosis.

Research Summary

This case report details a 44-year-old male who developed thoracic spinal cord myelopathy and cognitive decline due to nitrous oxide abuse from whipped cream canisters (whippits). Despite normal serum vitamin B₁₂ levels, the patient exhibited elevated methylmalonic acid (MMA), indicating vitamin B₁₂ deficiency, and MRI showed central cord involvement in the thoracic spine. The patient's condition did not improve with vitamin B₁₂ supplementation, highlighting the potential for irreversible neurological damage and the need for stricter regulation of whippit sales and improved diagnostic markers.

Practical Implications

Improved Diagnostic Criteria

The use of MMA and holoTC are more sensitive and specific biomarkers in detecting vitamin B₁₂ deficiency.

Public Health Awareness

Further studies are needed on public health initiatives that spread awareness of the long-term effects of nitrous oxide abuse.

Stricter Regulations

Greater regulatory efforts are needed to control the sale and distribution of whippits.

Study Limitations

1
The study is limited to a single case report, making it difficult to generalize findings to a larger population.
2
HoloTC was not available at the institution, limiting the diagnostic capabilities.
3
Further follow-up with serial neurologic exams is required to monitor the evolution of symptoms.

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