Subacute Combined Degeneration Caused by Nitrous Oxide Intoxication: A Report of Two Cases
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초록
We report two cases of subacute combined degeneration (SCD) caused by nitrous oxide (N2O) gas intoxication, which is rarely reported in Korea. Two patients recreationally inhaled N2O gas daily for several months. They presented with paresthesia of limbs, voiding difficulty, and gait disturbance. The initial vitamin B12 levels were normal or decreased, but homocysteine levels of the two patients were increased. Magnetic resonance imaging of the cervical spine showed T2-weighted hyperintensity in the bilateral dorsal columns of the cervical spinal cord. Electromyography and somatosensory evoked potential tests for both patients suggested posterior column lesion of the spinal cord combined with sensorimotor polyneuropathy. According to these findings, we concluded that the two patients had SCD. The patient’s symptoms partially improved after cessation of N2O gas inhalation and the receiving of vitamin B12 supplementation therapy. As the incidence of recreational N2O gas inhalation is increasing in Korea, physicians must be alert to the N2O induced SCD in patients presenting with progressive myelopathy.
Abstract
We report two cases of subacute combined degeneration (SCD) caused by nitrous oxide (N2O) gas intoxication, which is rarely reported in Korea. Two patients recreationally inhaled N2O gas daily for several months. They presented with paresthesia of limbs, voiding difficulty, and gait disturbance. The initial vitamin B12 levels were normal or decreased, but homocysteine levels of the two patients were increased. Magnetic resonance imaging of the cervical spine showed T2-weighted hyperintensity in the bilateral dorsal columns of the cervical spinal cord. Electromyography and somatosensory evoked potential tests for both patients suggested posterior column lesion of the spinal cord combined with sensorimotor polyneuropathy. According to these findings, we concluded that the two patients had SCD. The patient’s symptoms partially improved after cessation of N2O gas inhalation and the receiving of vitamin B12 supplementation therapy. As the incidence of recreational N2O gas inhalation is increasing in Korea, physicians must be alert to the N2O induced SCD in patients presenting with progressive myelopathy.
참고문헌 (10)
- Lin RJ, "Subacute combined degeneration caused by nitrous oxide intoxication : case reports", Acta Neurol Taiwan, 20, pp.129~137 (2011)
- Hsu CK, "Myelopathy and polyneuropathy caused by nitrous oxide toxicity : a case report", Am J Emerg Med, 30, pp.1016~ (2012)[DOI]
- Katsaros VK, "MRI of spinal cord and brain lesions in subacute combined degeneration", Neuroradiology, 40, pp.716~719 (1998)
- Timms SR, "Subacute combined degeneration of the spinal cord : MR findings", AJNR Am J Neuroradiol, 14, pp.1224~1227 (1993)
- Shoults K, "Case report : neurological complications of nitrous oxide abuse", B C Med J, 58, pp.192~194 (2016)
- Pema PJ, "Myelopathy caused by nitrous oxide toxicity", AJNR Am J Neuroradiol, 19, pp.894~896 (1998)
- Ozkan FU, "Progressive subacute combined degeneration : a severe relapse with dis-continuation of vitamin B12 treatment", Turk J Phys Med Rehabil, 62, pp.369~372 (2016)
- Vasconcelos OM, "Potential outcome factors in subacute combined degeneration : review of observational studies", J Gen Intern Med, 21, pp.1063~1068 (2006)
- Singer MA, "Reversible nitrous oxide-induced myeloneuropathy with pernicious anemia : case report and literature review", Muscle Nerve, 37, pp.125~129 (2008)
- 권영주, "아산화질소의 만성 남용에 의한 척수신경병증 1예", 대한신경과학회지, 21(4), pp.19~435 (2003), 대한신경과학회