An unusual case of subacute combined degeneration due to nitrous oxide abuse, which relapsed after bariatric surgery: A case report. Issue 35 (2nd September 2022)

• Record Type: Journal Article
• Authors: Chen, Wei; Si, Zhihua; Bi, Yanping; Yang, Bing
• Is Part Of: Medicine. Volume 101:Issue 35(2022)
• Page Start: e30442
• Publication Date: 2022-09-02
• Subjects: bariatric surgery -- nitrous oxide -- subacute combined degeneration -- vitamin B12 deficiency; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000030442
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Rationale: Several studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N2O) abuse. However, few studies have reported that N2O-induced SCD recurred because of sleeve gastrectomy after neurological symptoms improved. Patient concerns: We report the case of an 18-year-old woman who developed paresthesia, weakness in 4 limbs, and an unstable gait after frequent, excessive N2O inhalation. Diagnosis: The patient was diagnosed as having SCD. Interventions and outcomes: Nineteen days after intravenous mecobalamin and supplementation with other kinds of vitamin B, her weakness and paresthesia resolved. However, 7 months after discharge, the patient experienced recurrence following sleeve gastrectomy. Blood biochemistry revealed low vitamin B12 levels. After a 22-day treatment, similar to the first hospitalization, her residual numbness and unsteady gait improved. Lessons: This case highlights that patients, especially those at high risk of vitamin B12 deficiency, undergoing sleeve gastrectomy require careful nutritional follow-up and routine monitoring of micronutrients such as vitamin B12 and homocysteine. Continuous vigilance is essential for patients with common and rare neurological complications.