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