Reversible nitrous oxide-induced myeloneuropathy with pernicious anemia: case report and literature review

Muscle Nerve. 2008 Jan;37(1):125-9. doi: 10.1002/mus.20840.

Abstract

A previously healthy 27-year-old woman developed a subacute myeloneuropathy after receiving nitrous oxide anesthesia for dental procedures. Neurologic evaluation revealed that she was vitamin B(12) deficient due to underlying pernicious anemia. Discontinuation of nitrous oxide and supplementation with vitamin B(12) resulted in dramatic clinical improvement, with near-complete normalization of her neurologic examination. This case and published reports reviewed here emphasize that favorable outcomes are possible following prompt recognition and treatment of vitamin B(12) deficiency.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anemia, Pernicious / complications
  • Anemia, Pernicious / drug therapy
  • Anemia, Pernicious / physiopathology*
  • Anesthetics, Inhalation / adverse effects*
  • Female
  • Humans
  • Leg / innervation
  • Leg / physiopathology
  • Magnetic Resonance Imaging
  • Nerve Fibers, Myelinated / metabolism
  • Nerve Fibers, Myelinated / pathology
  • Nitrous Oxide / adverse effects*
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / metabolism
  • Peripheral Nervous System Diseases / physiopathology
  • Spinal Cord / metabolism
  • Spinal Cord / pathology
  • Spinal Cord / physiopathology
  • Spinal Cord Diseases / chemically induced*
  • Spinal Cord Diseases / metabolism
  • Spinal Cord Diseases / physiopathology
  • Treatment Outcome
  • Vitamin B 12 / pharmacology
  • Vitamin B 12 / therapeutic use
  • Vitamin B 12 Deficiency / complications*
  • Vitamin B 12 Deficiency / drug therapy
  • Vitamin B 12 Deficiency / metabolism

Substances

  • Anesthetics, Inhalation
  • Nitrous Oxide
  • Vitamin B 12