Neuropathy After Nitrous Oxide Abuse

Abstract

To the Editor.— I recently encountered two unusual cases. A husband and wife had progressive symptoms for several weeks suggesting severe peripheral neuropathy with substantial sensory impairment and posterior column signs. Inquiry about common exposure to potential neurotoxins disclosed that both habitually inhaled nitrous oxide (N 2 O) to achieve highs; indeed, they were in the business of distributing N 2 O and other paraphernalia to the head shop trade throughout the area. Their preferred method was to inhale the contents of balloons inflated from N 2 O canisters manufactured to make whipped cream. The husband admitted using up to 100 balloons three or four times a week for more than a year. He had failed to make the connection between his habit and the neurological symptoms and, rather authoritatively, insisted that N 2 O was safe and that he knew thousands of users, none of whom had suffered any