Intended for healthcare professionals

Endgames Case Review

Subacute progressive sensorimotor symptoms

BMJ 2019; 365 doi: (Published 11 June 2019) Cite this as: BMJ 2019;365:l1923
  1. Anna Francis, ST3 neurology,
  2. Robert Crossley, consultant neuroradiology,
  3. Stefen Brady, consultant neurology
  1. Neurosciences Department, Southmead Hospital, Bristol, UK
  1. Correspondence to A Francis anna.francis11{at}

A 24 year old woman presented with a three week history of numbness ascending from her ankles to her chest and affecting her hands.

She drank 20 units of alcohol at weekends, occasionally used cocaine, and had used recreational nitrous oxide (N2O) several times a month for the preceding four months. Her symptoms started following what she described as “excessive” N2O use three weeks earlier.

She had mild, symmetrical distal weakness of her upper and lower limbs, and needed assistance to walk. She had impaired sensitivity to pinprick and fine touch …

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