A rise in cases of nitrous oxide abuse: neurological complications and biological findings
- 10 July 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Zeitschrift für Neurologie
- Vol. 269 (2), 577-582
- https://doi.org/10.1007/s00415-021-10702-7
Abstract
Background The recent lockdown due to the COVID-19 pandemic has been linked to a higher incidence of psychiatric manifestations and substance abuse. The recreative use of nitrous oxide is more and more widespread and neurological complications are frequent. Methods We report clinical characteristics and biological findings of five consecutive patients presenting to our tertiary care center between April 2020 and February 2021 with various neurological symptoms occurring after recent nitrous oxide abuse. Results Our patients presented with subacute combined degeneration of the spinal cord (4/5 patients) or with acute inflammatory demyelinating polyneuropathy (1/5 patients). No patient had reduced vitamin B-12 titer, but all had elevated blood levels of homocysteine and methylmalonic acid. This reflects the functional deficit in vitamin B-12 that can be linked to nitrous oxide consumption. After vitamin B-12 supplementation, clinical signs regressed at least partially in all 5 patients. Conclusion We report an elevated incidence of neurological complications of nitrous oxide abuse occurring during the recent COVID-19 lockdown. Nitrous oxide abuse should be tracked down in patients presenting with compatible neurological symptoms and elevated homocysteinemia. Vitamin B-12 should be supplemented as soon as the diagnosis is made.This publication has 10 references indexed in Scilit:
- Nitrous oxide-induced toxic leukoencephalopathyBMJ Case Reports, 2020
- An Acute, Severe Axonal Sensorimotor Polyneuropathy in the Setting of Nitrous Oxide AbuseThe Neurohospitalist, 2020
- Nitrous Oxide Induced Posterior Cord Myelopathy: Beware of the Methyl Folate TrapCureus, 2020
- The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatmentPsychiatry Research, 2020
- Nitrous oxide-induced demyelination: Clinical presentation, diagnosis and treatment recommendationsJournal of the Neurological Sciences, 2020
- Nitrous oxide recreational abuse presenting with myeloneuropathy and mimicking Guillain-Barre syndromeIntractable & Rare Diseases Research, 2020
- No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalationZeitschrift für Neurologie, 2018
- Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literatureThe American Journal on Addictions, 2016
- Recreational nitrous oxide use: Prevalence and risksRegulatory Toxicology and Pharmacology, 2015
- Subacute combined degeneration of the spinal cord in cblC disorder despite treatment with B12Molecular Genetics and Metabolism, 2006