Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic

Vollhardt, Raphael; Mazoyer, Julie; Bernardaud, Lucy; Haddad, Andrei; Jaubert, Pauline; Coman, Irène; Manceau, Philippe; Mongin, M; Degos, Bertrand

doi:10.1007/s00415-021-10748-7

Cited by 18 publications

(16 citation statements)

References 15 publications

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“…The main clinical manifestations of neurological diseases caused by long-term abuse of nitrous oxide are peripheral neuropathy, subacute combined degeneration, spinal cord disease, and psychiatric symptoms [6][7][8][10][11][12]. The most common complaints of patients are limb numbness, weakness and unsteady gait.…”

Section: Plos Onementioning

confidence: 99%

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

et al. 2022

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Objective The objective was to analyze the clinical characteristics and pathological characteristics of sural biopsy in nitrous oxide (N2O) -induced peripheral neuropathy. Methods We recruited 18 patients with N2O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, and nerve conduction studies. Seven patients underwent sural nerve biopsy pathologic examination. Results All 18 patients had polyneuropathy, the nerve conduction results showed significant reductions in motor and sensory amplitudes, slowing of conduction velocities, and prolongation of latencies in most tested nerves compared to the controls. Toluidine blue staining of semi-thin sections of sural nerve biopsy showed decreased myelinated nerve fiber density, increased thin myelinated nerve fiber density, and axonal regeneration. Electron microscopy showed axonal degeneration and nerve regeneration. Conclusion The main manifestations of peripheral nerve damage caused by the abuse of N2O are lower limb weakness and distal sensory disorder. The nerve conduction study results demonstrated that mixed axonal and demyelinating neuropathy was the most common type of neuropathy. Sural biopsy showed the main pathological change was chronic axonal degeneration.

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Section: Plos Onementioning

confidence: 99%

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

et al. 2022

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“…Aside from laboratory abnormalities, including anemia, increased homocysteine, and low transcobalamin levels in serum, the lack of enhancement might be a useful red flag. Nitrous oxide exposure can also lead to a myelopathy with similar features, since it deactivates vitamin B12, and this more acute myelopathy can occasionally be accompanied by gadolinium enhancement, mimicking inflammatory or neoplastic etiologies ( 118 ). Copper deficiency has similar MRI characteristics, but preferentially involves the cervical segment extending to the central spinal cord ( 119 ).…”

Section: Mimics and Pitfallsmentioning

confidence: 99%

Neuroimaging features in inflammatory myelopathies: A review

et al. 2022

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Spinal cord involvement can be observed in the course of immune-mediated disorders. Although multiple sclerosis (MS) represents the leading cause of inflammatory myelopathy, an increasing number of alternative etiologies must be now considered in the diagnostic work-up of patients presenting with myelitis. These include antibody-mediated disorders and cytotoxic T cell-mediated diseases targeting central nervous system (CNS) antigens, and systemic autoimmune conditions with secondary CNS involvement. Even though clinical features are helpful to orient the diagnostic suspicion (e.g., timing and severity of myelopathy symptoms), the differential diagnosis of inflammatory myelopathies is often challenging due to overlapping features. Moreover, noninflammatory etiologies can sometimes mimic an inflammatory process. In this setting, magnetic resonance imaging (MRI) is becoming a fundamental tool for the characterization of spinal cord damage, revealing a pictorial scenario which is wider than the clinical manifestations. The characterization of spinal cord lesions in terms of longitudinal extension, location on axial plane, involvement of the white matter and/or gray matter, and specific patterns of contrast enhancement, often allows a proper differentiation of these diseases. For instance, besides classical features, such as the presence of longitudinally extensive spinal cord lesions in patients with aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), novel radiological signs (e.g., H sign, trident sign) have been recently proposed and successfully applied for the differential diagnosis of inflammatory myelopathies. In this review article, we will discuss the radiological features of spinal cord involvement in autoimmune disorders such as MS, AQP4+NMOSD, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and other recently characterized immune-mediated diseases. The identification of imaging pitfalls and mimics that can lead to misdiagnosis will also be examined. Since spinal cord damage is a major cause of irreversible clinical disability, the recognition of these radiological aspects will help clinicians achieve a correct and prompt diagnosis, treat early with disease-specific treatment and improve patient outcomes.

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“…Frequent and heavy use (up to 700 whippets per day) has been reported in Australia [ 14 ]. This is of serious concern because repeated exposure to high doses of N 2 O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N 2 O-induced cobalamin deficiency [ 15 , 16 , 17 , 18 , 19 ]. The increasing trend of recreational users with N 2 O-induced neurological damage at emergency departments confirms the urgency of this development [ 9 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the recent introduction and availability of larger tanks or ‘smart whip’ cylinders, containing 0.6–10 kg of N 2 O, have certainly facilitated higher repeated N 2 O dosing and N 2 O abuse in the Netherlands [ 8 ] and France [ 22 ]. Others, such as those in France or China, claim that N 2 O abuse has increased during the COVID-19 pandemic due to boredom as a result of the lock-downs [ 12 , 18 , 23 ], although evidence for this claim is rather weak.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review

Brunt

Brink

Amsterdam

2022

IJMS

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The recreational use of nitrous oxide (N2O) has increased over the years. At the same time, more N2O intoxications are presented to hospitals. The incidental use of N2O is relatively harmless, but heavy, frequent and chronic use comes with considerable health risks. Most importantly, N2O can inactivate the co-factor cobalamin, which, in turn, leads to paresthesia’s, partial paralysis and generalized demyelinating polyneuropathy. In some patients, these disorders are irreversible. Several metabolic cascades have been identified by which N2O can cause harmful effects. Because these effects mostly occur after prolonged use, it raises the question of whether N2O has addictive properties, explaining its prolonged and frequent use at high dose. Several lines of evidence for N2O’s dependence liability can be found in the literature, but the underlying mechanism of action remains controversial. N2O interacts with the opioid system, but N2O also acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, by which it can cause dopamine disinhibition. In this narrative review, we provide a detailed description of animal and human evidence for N2O-induced abuse/dependence and for N2O-induced neurotoxicity.

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Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic

Cited by 18 publications

References 15 publications

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

Neuroimaging features in inflammatory myelopathies: A review

Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review

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