Subacute Combined Degeneration from Nitrous Oxide Abuse

Laughing Ceased, Nitrous Oxide-Induced Myelopathy Evolved

“…Demyelination of the posterior and lateral columns of the spinal cord causes the most common neurological finding, SCD. 4 S-adenosyl methionine, a crucial methyl donor for methylation of myelin protein, is produced by the methionine synthetase from homocysteine by the cofactor of vitamin B 12 (Figure 2). Our patient's neurological signs, except for his stimulus-sensitive generalized myoclonus, are explained by the diagnosis of SCD, which responded to vitamin B 12 replacement.…”