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Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders

Authors Bao L, Li Q, Li Q, Chen H, Zhang R, Shi H, Cui G

Received 1 November 2019

Accepted for publication 13 March 2020

Published 15 April 2020 Volume 2020:16 Pages 977—984


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jun Chen

Lei Bao,* Qing Li,* Qingjie Li, Hao Chen, Ruixue Zhang, Hongjuan Shi, Guiyun Cui

Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lei Bao
Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, People’s Republic of China
Tel/Fax +86 516 85802129

Purpose: We summarized the clinical manifestations, laboratory and electrodiagnostic characteristics and magnetic resonance imaging (MRI) findings of nitrous oxide (N2O) abuse-induced neurological disorders.
Patients and Methods: We retrospectively reviewed 33 patients with N2O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, nerve conduction studies, together with spinal and brain MRI.
Results: The most frequent clinical manifestations included numbness and weakness in the extremities and unspecified gait disturbance. Low serum vitamin B12 levels were found in 9 patients, and high homocysteine levels were noted in 27 patients. Nerve conduction studies showed a sensory-motor neuropathy. Sixteen patients showed bilateral high-intensity T2 signal within the posterior column on spinal MRI, and four patients showed cerebral white matter lesions on brain MRI.
Conclusion: N2O abuse has become a significant public health problem because of the severe neurological disorders related to chronic abuse. Clinical physicians should be aware of the toxic effects of N2O.

Keywords: nitrous oxide, neurological disorders, subacute combined degeneration, neuropathy, vitamin B12

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