- Whippits (AKA poppers)
- small canisters of compressed nitrous oxide, intended for whipped cream dispensers, but abused as a recreational drug
- prolonged use leads to functional inactivation of vitamin B12 through oxidation of cobalt ions
- treat with high-dose IM B12 replacement (and counsel against whippit use!)
- HIV myelopathy
- path shows vacuolization in the lateral and posterior columns of the thoracic spinal cord
- characterized by slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency
- most common in late stages of AIDS
- found in up to 30-50% of patients with AIDS at autopsy
- HIV associated distal peripheral sensory neuropathy
- most common neurological problem in AIDS
- characterized by paresthesias (burning, numbness, shock-like sensations), ascending over time, also can involve the hands in a glove like fashion
- decreased vibratory, temperature, and pinprick sensation
- most don’t develop motor weakness or muscle wasting until late in the course
- Jaw jerk: elicited by placing index finger over the middle of the patient’s chin with the mouth slightly open and the jaw relaxed. the index finger is then tapped with a reflex hammer
- tests sensory portion of trigeminal nerve and motor V3 branch of the trigeminal nerve
- normal response: no significant movement of the jaw
- abnormal response: jaw deviates toward the side of weakness; or pathologically brisk jerking of the jaw with lesions above the 5th nerve motor nucleus
DiRocco A, Simpson DM. AIDS-associated vaculolar myelopathy. AIDS Patient Care STDS. 1998 Jun; 12(6):457-61.
Singer EJ, Sueiras MV, Commins D, Levine, A Neurologic Presentations of AIDS. Neurol Clin 2010. Feb; 28(1) 253-275.
Thompson, AG, Leite MI, Lunn MP, Bennett DL. Whippits, nitrous oxide and the dangers of legal highs. Pract Neurol 2015; 15: 207-209.