Recreational Nitrous Oxide-Induced Subacute Combined Degeneration

Omotosho, Yetunde B; Ying, Grace W; Orji, Richard; Patel, Hereen

doi:10.7759/cureus.23409

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…We identified 154 patients meeting our inclusion criteria after reviewing the literature 5–68 . There was a predominance of males (n=94, 61%), and the median age was 22 [19 to 26] years.…”

Section: Case Seriesmentioning

confidence: 99%

Neurological Manifestations Induced by Nitrous Oxide Abuse

Pichon,

Majhadi,

Menn

2023

The Neurologist

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Introduction: Nitrous oxide (NO) abuse is increasing among young people. This can result in severe neurological disorders such as myelopathy and/or peripheral neuropathy. We report the clinical presentations, biological, radiologic and electrophysiological findings of 5 patients hospitalized with neurological symptoms consecutive to NO abuse. In addition, a literature review was conducted to describe the neurological characteristics and to identify factors associated with a poor recovery. Case report: Among the 5 patients included, 2 had a myeloneuropathy, 2 had a sensorimotor neuropathy, and 1 had a normal spinal cord magnetic resonance imaging and electromyography despite neurological manifestations consistent with myeloneuropathy. After vitamin B12 supplementation, recovery was reported in 4 patients, and 1 was lost to follow-up. From the literature review, 154 patients were included [94 males; median age 22 (19 to 26) y; NO exposure 9 (3 to 18) mo]. A myelopathy was identified in 116 patients (75%) and a peripheral neuropathy was documented in 89 patients (58%). Compared with patients who recovered, those with sequelae were more likely to have a motor deficit at presentation (P<0.001), to use NO regularly (P<0.001), to have a lower vitamin B12 level (P=0.04), and a higher concentration of homocysteine (P=0.04). A less extensive myelopathy was more frequently found in the group with favorable outcomes (P=0.002). Conclusion: Neurological disorders caused by NO may be challenging with severe clinical patterns. We identified several factors associated with a poor recovery, to make clinicians aware of NO-induced neurotoxicity.

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Section: Case Seriesmentioning

confidence: 99%

Neurological Manifestations Induced by Nitrous Oxide Abuse

Pichon,

Majhadi,

Menn

2023

The Neurologist

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Subacute combined degeneration: When neuroimaging complements the clinic—A case report

Antunes Pereira,

Pereira Rodrigues,

Canedo M Jr

et al. 2023

Int J Case Rep Images

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Introduction: Low serum B vitamin levels are potentially causally related to these prevalent mental symptoms. Because of this, cobalamin—vitamin B12—is crucial for producing myelin and neurotransmitters. Additionally, subacute combined degeneration (SCD) is one of the consequences of B12 deficiency. Symptomatology often is paraplegia, spasticity, and contractures which are typically progressive. In addition, as the disease advances, they experience a distal sensorimotor loss that ascends proximally and causes spastic quadriparesis and generalized hypoesthesia. Case Report: Male, 33 years old, with a history of a fall in December 2015, when pain and discomfort started in the left lower limb. A year ago, she evolved with paraparesis, loss of sphincter control, sensory changes in the extremities of the limbs and sensory level at T10, in addition to a report of visual disturbance in the left eye. At that time, the dosage of vitamin B12 was very low—50 pg/mL (reference above 300 pg/mL). On physical examination: extrapyramidal syndrome with hypoesthesia at the distal level. Bilateral Hoffmann’s sign, spastic paraparesis, hyperreflexia in the lower limbs, clonus in the feet, and loss of sphincter control. Sensitive level at T10. Magnetic resonance imaging (MRI) showed cervical dorsal lumbar spinal cord and cone with hypersignal focus on the lateral and posterior cords and skull hypersignal focus in the topography of the corticospinal tracts, suggestive of combined subacute degeneration. Conclusion: Vitamin B12 deficiency, in addition to other pathologies, is also found in SCD. When treated early, these alterations found in the imaging exam can be resolved without signs of atrophy. Thus, neuroimaging plays a relevant role in the diagnosis, complementing the clinic.

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Recreational Nitrous Oxide-Induced Subacute Combined Degeneration

Cited by 2 publications

References 9 publications

Neurological Manifestations Induced by Nitrous Oxide Abuse

Neurological Manifestations Induced by Nitrous Oxide Abuse

Subacute combined degeneration: When neuroimaging complements the clinic—A case report

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