Abstract
Ahn SC, Brown AW. Cobalamin deficiency and subacute combined degeneration after nitrous
oxide anesthesia: a case report.
We report on a diabetic man in his early forties with a history of disabling left-hemisphere
stroke and hyperhomocystinemia who developed new sensorimotor symptoms and urinary
incontinence 4 weeks after prolonged exposure to nitrous oxide (N2O) related to arterial occlusive disease and amputation. Physical examination at rehabilitation
hospital admission showed preexisting severe nonfluent multimodality language impairment,
new ataxic quadriparesis superimposed on static spastic right hemiparesis, diffusely
blunted muscle stretch reflexes, impaired cutaneous sensation and proprioception,
diminished alternating motion rates, and impaired truncal balance. Laboratory tests
revealed low serum cobalamin and hyperhomocystinemia. Magnetic resonance imaging of
the spinal cord showed dorsal T2-signal hyperintensity. Treatment included vitamin
replacement and comprehensive rehabilitation. His response to hospital-based and outpatient
treatment led to successful prosthetic fitting. This case shows the importance of
screening for and treating cobalamin deficiency before exposing patients with known
risk to N2O and highlights the potential diagnostic and therapeutic challenges of subacute combined
degeneration when it occurs with a setting of preexisting disabling neurologic impairment.
Key words
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.
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© 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
