A 31-Year-Old Female Presented to the Emergency Room with a 4-Month

A 31-year-old female presented to the emergency room with a 4-month history of imbalance, limb weakness, and numbness and tingling from her toes to her waist as well as in the hands. She desired immediate medical attention after awakening with complete numbness from the chest to the toes. Physical examination showed decreased pinprick and light touch response from her waist to her toes as well as to her hands. Vibration sensation was also diminished in the feet and hands. Motor examination demonstrated generally decreased strength in all extremities. Magnetic resonance imaging (MRI) revealed no abnormalities although the posterior spinal columns demonstrated increased signal. Standard lab values were normal. The patient did not immediately disclose N₂O abuse; however, prior to additional testing the patient admitted to regularly abusing N₂O via a N₂O machine. Over the last 2 years, she admitted to using N₂O for 1-2 hour sessions several times a week.
-Discuss signs that could have alerted colleagues that this individual might have been abusing nitrous-oxide in the office.