Abstract
BackgroundNitrous oxide (N2O), a long-standing anesthetic, is also neurotoxic by interfering with the bioavailability of vitamin B12 if abused. A few case studies have reported the neurological and psychiatric complications of N2O.Case presentationHere, we reported a patient of N2O induced subacute combined degeneration (SCD) with longitudinally extensive myelopathy with inverted V-sign exhibiting progressive limb paresthesia and unsteady gait.ConclusionsThis case raises the awareness of an important mechanism of neural toxicity of N2O, and clinical physicians should be well recognized this in the field of substance-related disorders.
Highlights
Nitrous oxide (N2O), a long-standing anesthetic, is neurotoxic by interfering with the bioavailability of vitamin B12 if abused
N2O, a well-known anesthetic, has a long history for its recreational use, and its consumption is on the rise rapidly [2]
There are only 18 cases describing subacute combined degeneration (SCD) caused by N2O abuse
Summary
Nitrous oxide (N2O) is a long-standing anesthetic, which has neurotoxicity by interfering in the bioavailability of vitamin B12 if abused. A few case studies have reported the neurological and psychiatrical complications, even death, related to N2O abuse [1]. Among these complications, N2O-induced myelopathy has been regarded as the most common manifestation [1]. We described a 20-year-old female who developed SCD with inverted V-sign on spinal column related to the abuse of N2O. The spinal cord MRI showed abnormal longitudinally extensive T2 weighted hyperintensities involving the posterior columns from C1 through T12, with inverted V or “rabbit ears” sign on cervical spinal MRI, but without contrast enhancement
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