Paralysis caused by nagging

A woman in her 20s presented to the emergency department, malnourished and dehydrated, and with acute paralysis of the lower limbs. Over the previous 10 days, she had inhaled nitrous oxide from whipped-cream bulbs (10-20 per day) for pain caused by a sprained ankle. She had a history of intravenous drug use and was on a methadone program. The nitrous oxide misuse combined with the malnutrition, with low vitamin B,2 levels, apparently resulted in subacute combined degeneration of the spinal cord-a rare complication of nitrous oxide misuse.