Recurrent paraparesis and death of a patient with ‘whippet’ abuse

Abstract

Nitrous oxide is increasingly used as a recreational drug that is easily and legally available worldwide. Occasional nitrous oxide use has been considered relatively safe without the development of addiction or major adverse effects. However, heavy long-term nitrous oxide abuse can be associated with severe neurological complications, and even deaths have been described. The characteristic presentation is myeloneuropathy with dorsal column degeneration and demyelinating sensory polyneuropathy related to vitamin B12 deficiency. Described is a 23-year-old male who developed recurrent paraparesis related to nitrous oxide abuse. A second, more severe, episode of paraparesis was associated with predominantly lower motor neuron damage. A partial recovery was achieved by discontinuation of nitrous oxide use and initiation of vitamin B12 supplementation. However, the patient relapsed and ultimately died while being intoxicated with several abusive substances. The case adds to the cumulative literature about the clinical phenomenology and dangers of nitrous oxide abuse.

A model of lipid dysregulation and altered nutrient status in Alzheimer's disease

“…Recent case reports have also provided anecdotal evidence associating chronic N 2 O use with subacute combined degeneration and limb weakness [12], myeloneuropathy [13], pernicious anemia [14], hematologic changes and risk of thrombosis [15,16], myocardial infarction [17], pneumomediastinum [18], vitamin B12 deficiency with lower motor neuronal degeneration [19,20], and stroke [21], and many conditions that are considered significant risk factors for AD onset, including headache [22], anemia [23], gait imbalance/ataxia [24], thrombosis [25], stroke [26], and myocardial infarction [27]. Moreover, clinical evidence suggests that trace N 2 O exposure induces impairments in the Digit Span Test [28], a test that has predictive power in identifying cognitive decline in participants with mild cognitive impairment (MCI)—a condition often prodromal to AD [29].…”

An Acute, Severe Axonal Sensorimotor Polyneuropathy in the Setting of Nitrous Oxide Abuse

“…Most commonly seen is a predominant sensory subacute myeloneuropathy involving the dorsal columns of the spinal cord, 1 though peripheral neuropathies and neuropsychiatric symptoms have also been reported. 3,4 “Pseudo” Guillain-Barré syndrome in the context of N 2 O abuse has rarely been reported. 5 Here, we report an adolescent girl with chronic heavy N 2 O abuse who presented with progressive ascending weakness of the lower limbs, areflexia, and sensory loss, resembling Guillain-Barré syndrome.…”

Polydrug abuse associated with nitrous oxide causes death

“…The case report by Hirvioja et al raises some interesting points [ 1 ]. Unfortunately, the title is somewhat misleading because it suggests that it was nitrous oxide alone that caused the death and ignores the likelihood, from the data presented, that the death was probably due to the other substances found in the patient's blood as well as the nitrous oxide [ 1 ].…”

“…The case report by Hirvioja et al raises some interesting points [ 1 ]. Unfortunately, the title is somewhat misleading because it suggests that it was nitrous oxide alone that caused the death and ignores the likelihood, from the data presented, that the death was probably due to the other substances found in the patient's blood as well as the nitrous oxide [ 1 ]. As far as I am aware, there is no case in the literature where nitrous oxide alone has caused sudden death during misuse, except when the subject has been asphyxiated because of oxygen lack [ 2 ].…”

“…Their paper also highlights the point that pure nitrous oxide abuse is extremely rare and that those who do abuse it do so as part of their polydrug abuse [ 1 , 4 ].…”