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Ascending Paralysis in A Young Adult Male: Nitrous Oxide-Induced Functional Vitamin B12 Deficiency Mimicking Guillain-Barré Syndrome

Year: 2025

Type: article

Abstract: BACKGROUND: Ascending paralysis is a classic presentation of Guillain-Barré Syndrome (GBS), but other etiologies such as nutritional or toxic neuropathies can mimic its features. Differentiating among these causes is critical for appropriate management. CASE REPORT: A 30-year-old male presented with progressive ascending weakness concerning for GBS. Neurologic examination revealed areflexia and sensory deficits. However, cerebrospinal fluid analysis and electromyography were inconsistent with GBS. Further history revealed frequent recreational use of nitrous oxide. Laboratory evaluation showed functional vitamin B12 deficiency. The patient improved with cessation of nitrous oxide and vitamin B12 supplementation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of considering metabolic and toxic mimics in patients presenting with acute flaccid paralysis. Emergency physicians should inquire about nitrous oxide use in young patients with atypical neurologic presentations, as timely diagnosis and treatment can prevent long-term neurologic damage.

Source: Journal of Emergency Medicine

DOI: 10.1016/j.jemermed.2025.08.034

Authors: Ashley Heaney, Negin Ceraolo, Erin L Simon

Institutions: Cleveland Clinic Akron General, Northeast Ohio Medical University

Language: English

Topic: Peripheral Neuropathies and Disorders

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,390