Co-Occurring Subacute Combined Degeneration and Guillain-Barré Syndrome Resulting From Nitrous Oxide Abuse: A Case Report

Abstract

Growing in prevalence as a recreational drug of abuse across a broad scope of people, nitrous oxide (N 2 O) has proven to be a public health concern. Side effects of its abuse have a great degree of variation among people ranging from neurologic, psychiatric, and medical symptoms. We present a rare case of a 23-year-old female with a history of N 2 O abuse, who presented with symptoms of both subacute combined degeneration syndrome (SCD) and Guillain-Barré syndrome (GBS). She presented with three weeks history of progressive bilateral lower extremity weakness, burning and tingling sensation, difficulty walking, and falls. This patient underwent an extensive medical workup upon hospitalization. Notable findings of the magnetic resonance imaging (MRI) of her cervical spine showed an abnormal cervical cord signal intensity pattern typical for vitamin B 12 deficiency and her lumbar puncture showed albuminocytological dissociation, which confirmed the diagnosis of GBS. For these conditions, this patient was successfully treated with weekly vitamin B 12 injections and five treatments of plasmapheresis. Her condition was additionally complicated by worsening anxiety and depression, which were treated with gabapentin, escitalopram, trazodone, hydroxyzine, and melatonin. She demonstrated great clinical improvement with almost complete resolution of her symptoms at the time of her hospital discharge. This case highlights the easy accessibility, addiction potential, and adverse consequences related to N 2 O abuse.

Nitrous Oxide as an Emerging Cause of Subacute Combined Degeneration and Polyneuropathy: A Two-Case Report

“…The clinical presentation of our cases is similar to that of cases previously described by other authors [ 3 , 10 , 11 , 13 , 14 , 18 , 19 ]. They exhibit certain characteristics that need to be highlighted.…”

“…Second, they presented with initial characteristics similar to GBS, and the discovery of albumin-cytological dissociation in one of our patients strongly suggested such a diagnosis. The co-occurrence of GBS with SCD in a patient with N 2 O consumption has previously been reported [ 18 , 19 ]. It is possible that an inflammatory response capable of inducing a condition similar to GBS may occur.…”