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BJA Advance Access originally published online on December 16, 2005
British Journal of Anaesthesia 2006 96(2):222-225; doi:10.1093/bja/aei300
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

CASE REPORT

Reversible nitrous oxide myelopathy and a polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase

H. J. Lacassie1,3,*, C. Nazar1, B. Yonish4, P. Sandoval2, H. A. Muir3 and P. Mellado2

1 Department of Anesthesiology and 2 Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile. 3 Department of Anesthesiology and 4 Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA

* Corresponding author: Department of Anesthesiology, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago 833-0024, Chile. E-mail: lacassie{at}med.puc.cl

We present a case of a patient who received nitrous oxide on two occasions within a period of 8 weeks and who subsequently developed a diffuse myelopathy, characterized by upper extremity paresis, lower extremity paraplegia and neurogenic bladder. Laboratory testing revealed hyperhomocysteinaemia and low levels of vitamin B12. Because of this uncommon clinical presentation, we analysed the patient's DNA, and found a polymorphism in the MTHFR gene that is associated with the thermolabile isoform of the 5,10-methylenetetrahydrofolate reductase enzyme, which explained the myelopathy experienced by the patient after being exposed to nitrous oxide. Soon after initiating supplementary therapy with folic acid and vitamin B12, the neurological symptoms subsided.


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