UMEM Educational Pearls

Title: Physical exam findings in chronic nitrous oxide abuse

Category: Toxicology

Keywords: nitrous oxide abuse, neurologic findings, physical exam (PubMed Search)

Posted: 8/13/2020 by Hong Kim, MD
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What physical exam findings are associated with nitrous oxide abuse?

 

 

 

 

Nitrous oxide (NO) inhalation abuse, also called “whip-its” or “whippets”, inactivates vitamin B12 and create a vitamin B12 deficiency state. Chronic abuse of nitrous oxide can result in neurologic deficits/findings affecting the posterior/dorsal column of the spinal cord. 

Physical exam findings: 

  1. Truncal ataxia
  2. Decreased vibratory sensation and proprioception in lower extremities
  3. Impaired coordination and rapid alternative movements
  4. Lhermitte’s sign: paresthesia of the upper and lower extremities associated with flexion of the head/neck.
  5. Rossolimo’s sign: exaggerated flexion of the toes when the tips of the toes are percussed