Неврологични усложнения при хроничната употреба на райски газ в юношеска възраст

Teodora Chamova; M. Ganeva; G. Tacheva; I. Litvinenko; M. Penkov; I. Tournev

doi:10.67667/NEU.v24i3.151

Authors

Teodora Chamova UMHAT "Alexandrovska"; Medical university – Sofia https://orcid.org/0000-0001-5142-5007
M. Ganeva University Pediatric Hospital "Prof. Ivan Mitev"; Medical university – Sofia
G. Tacheva University Pediatric Hospital "Prof. Ivan Mitev"; Medical university – Sofia
I. Litvinenko University Pediatric Hospital "Prof. Ivan Mitev"; Medical university – Sofia
M. Penkov UMHAT „St.Ivan Rilski”; Medical university – Sofia
I. Tournev UMHAT "Alexandrovska"; Medical university – Sofia; New Bulgarian University - Sofia, Bulgaria

DOI:

https://doi.org/10.67667/NEU.v24i3.151

Keywords:

Nitrous oxide, myeloneuropathy, vitamin B12, homocysteine, metylmalonic acid

Abstract

Nitrous oxide misuse in adolescence and young adults is a recognized issue worldwide. Prolonged abuse inactivates vitamin B12, causing a myeloneuropathy.
We present five patients, aged between 15 and 18 years with a mean N2O consumption of 10-12 canisters twice a week during the last 3 months to 2 years. At presentation, paresthesias and gait unsteadiness were common, and one patient was with severely impaired gait. NCS were consistent with mixed sensorimotor neuropathy with more severe involvement of the lower limbs. Serum B12 levels were decreased in 4/5 and normal in one patients. In contrast, mean serum homocysteine and metylmalonic acid were more than 7 times increased. Spinal magnetic resonance imaging (MRI) showed characteristic dorsal column T2 hyperintensities in 1 patients. Patients were treated with intramuscular vitamin B12, with variable functional recovery.
Nitrous oxide misuse can cause a severe but potentially reversible subacute myeloneuropathy. Neurological deficits can improve with abstinence and B12 supplementation, even in the most severely affected patients.

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