Nitrous Oxide as an Emerging Cause of Subacute Combined Degeneration and Polyneuropathy: A Two-Case Report (original) (raw)
Related papers
Frontiers in neurology, 2024
Under standard conditions, nitrous oxide (N 2 O) manifests as a colorless, odorless gas with a mildly sweet taste. The compound finds applications in various fields, including its use as an aerosol propellants, an accelerant in motor racing, and an anesthetic in surgical procedures and dentistry. Unfortunately, the recreational misuse of N 2 O has become prevalent among young individuals due to its euphoric and hallucinogenic effects. Compounding this issue is the fact that nitrous oxide can be easily obtained from over-the-counter household items, facilitating its non-medical use. The global community has witnessed a surge in the recreational utilization of nitrous oxide gas in recent years. Despite the widespread non-medical abuse of N 2 O, there remains inadequate understanding of the potential adverse effects resulting from exposure to it. This paper provides an overview of management findings, laboratory and electrodiagnostic characteristics, as well as clinical presentations associated with neurological disorders induced by nitrous oxide usage.
Subacute Combined Degeneration of the Spinal Cord Secondary to Nitrous Oxide Abuse
Cureus
Here, we report a case of subacute combined degeneration (SCD) of the spinal cord in the setting of nitrous oxide poisoning seen at the Medical Ward, Queen Elizabeth Hospital Birmingham Our patient was a 28-yearold lady who presented with impaired sensations in the lower limbs and difficulty walking for approximately one and a half months. Her clinical symptoms did not match common neurological conditions. Upon detailed history, she revealed that she had been frequently using nitrous oxide recreationally for several years. Although her baseline investigations were normal, her magnetic resonance imaging (MRI) of the spine showed bilateral symmetrical T2 hyperintense signal changes in the dorsal columns extending from C2 to C6 spinal segment. Based on history, clinical findings, and MRI of the cervical spine, the diagnosis of SCD of the spinal cord was made, and her symptoms fully resolved with treatment.
No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation
Journal of Neurology
Background Whilst the dangers of 'legal highs' have been widely publicised in the media, very few cases of the neurological syndrome associated with the inhalation of nitrous oxide (N 2 O) have been reported. Here we set out to raise awareness of subacute degeneration of the spinal cord arising from recreational N 2 O use so that formal surveillance programs and public health interventions can be designed. Methods Case series documenting the clinical and investigational features of ten consecutive cases of subacute degeneration of the spinal cord presenting to a hospital with a tertiary neurosciences service in East London. Results Sensory disturbance in the lower (± upper) limbs was the commonest presenting feature, along with gait abnormalities and sensory ataxia. MRI imaging of the spine showed the characteristic features of dorsal column hyperintensity on T 2 weighted sequences. Serum B 12 levels may be normal because subacute degeneration of the spinal cord in this situation is triggered by functional rather than absolute B 12 deficiency. Discussion A high index of suspicion is required to prompt appropriate investigation, make the diagnosis and commence treatment early. This is the largest reported series of patients with subacute degeneration of the spinal cord induced by recreational use of N 2 O. However, the number of patients admitted to hospital likely represents the 'tip of the iceberg', with many less severe presentations remaining undetected. After raising awareness, attention should focus on measuring the extent of the problem, the groups affected, and devising ways to prevent potentially long-term neurological damage.
Nitrous oxide-induced myeloneuropathy: an emerging public health issue
Irish Journal of Medical Science (1971 -), 2022
Increasing use of nitrous oxide as a recreational drug has been reported among young adults in western countries over the past decade. We present two cases of young males presenting to the Emergency Department (ED) of a large urban university hospital in Dublin with progressive neurological dysfunction related to nitrous oxide use. We review the pathophysiology, clinical features and treatment of nitrous oxide neurotoxicity. It is important that clinicians are aware of this evolving public health issue and are able to recognize the clinical features of this rare presentation, which may become more common in Irish EDs and GP surgeries as nitrous oxide abuse becomes more prevalent.