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Neurological Rehabilitation

(Kiosk 4) Whippet Abuse Causing Subacute Combined Degeneration of the Spinal Cord: A Case Report

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Sara Herzberg, MD

    Resident Physician
    Advocate Lutheran General Hospital, Park Ridge, IL; Rutgers New Jersey Medical School PM&R Program; Kessler Institute for Rehabilitation, West Orange, NJ
    Fair Lawn, New Jersey

    • Co-Author(s)

  • AS

    Amy Sun, MD

    Attending Physician
    Lutheran Gen Hospital
    Park Ridge, Illinois

Case Diagnosis: A 24 year-old female presenting with gait instability is found to have subacute combined degeneration in the spinal cord secondary to whippet use.

Case Description or Program Description: A 24-year-old female with a history of anemia, depression, alcoholic pancreatitis, and polysubstance abuse including whippet inhalation presented with a two-week-history of progressive bilateral lower extremity weakness, numbness, ataxia, and gait instability associated with falls. Physical exam revealed 5/5 strength throughout, profound bilateral lower extremity loss of proprioception and vibration sense, intact reflexes, and gait ataxia. Labs were notable for low B12 at 142 pg/mL (reference range 211-911 pg/mL) and normal creatinine phosphokinase, thiamine, and hemoglobin A1c. MRI brain and spine showed T2 hyperintensity within the dorsal spinal cord, most consistent with subacute combined degeneration.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: She received daily B12 intramuscular injections and her B12 level improved to 474 pg/mL. She completed a course of acute inpatient rehabilitation. Balance and gait improved from requiring moderate assistance on admission to being modified independent at discharge.

Discussion (relevance): Whippets are a new street drug that have increased in popularity over the past decade due to their accessibility and perceived low side effect profile. They are comprised of compressed nitrous oxide (N₂O) often inhaled from aerosol whipped cream canisters. N₂O disrupts the homocysteine-methionine cycle by oxidizing cobalt ions and inactivating B12, preventing the methylation of myelin proteins and subsequently demyelinating spinal dorsal column neurons. This ultimately causes neurological symptoms as seen in this patient.

Conclusions: Whippets have become an increasingly popular recreational drug. It is imperative that practitioners keep it on the differential in spinal cord injury in otherwise young, healthy patients.