Longitudinally Extensive Nitrous Oxide Myelopathy With Novel Radiographic Features

Ernst, Lia; Brock, Kenneth; Barraza, Luis H.; Davis, Adam; Nirenberg, Melissa J.

doi:10.1001/jamaneurol.2015.2141

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…Firstly, our case revealed symmetric abnormal signal in the dorsal columns of the cervical and thoracic cord, especially with inverted V-sign on cervical spinal. To the best of our knowledge, only one case has been previously described of such longitudinally extensive myelopathy induced by N2O [ 5 ]. Our case also indicated symmetric, reversible changes in the posterior columns correlating well with patients’ clinical symptoms after vitamin B12 supplementation.…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review

et al. 2017

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“…None of our four patients with brain MRI had any abnormalities; these have rarely been described and appear to be aspecific. Surprisingly, 2/12 patients showed spinal cord contrast enhancement which has only been rarely described [ 7 ]. To our knowledge, no cases of meningeal contrast enhancement have been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic

et al. 2021

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“…83,84 Gadolinium enhancement has been rarely reported. 83 Imaging abnormalities often improve or resolve with treatment. [84][85][86] An accompanying sensorimotor polyneuropathy with mixed axonal and demyelinating features is commonly seen on electrodiagnostic studies.…”

Section: Nitrous Oxide Toxicitymentioning

confidence: 99%

“…Treatment plans vary, but most regimens start with high-dose IM injections of 1 mg/day of cyanocobalamin. 75,77,83 In addition, methionine supplementation is sometimes administered. 3,4,88 With treatment, neurological symptoms improve in most patients.…”

Section: Nitrous Oxide Toxicitymentioning

confidence: 99%

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Metabolic and Toxic Myelopathies

Slama

Berkowitz

2021

Semin Neurol

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Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.

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Longitudinally Extensive Nitrous Oxide Myelopathy With Novel Radiographic Features

Cited by 9 publications

References 4 publications

Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review

Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review

Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic

Metabolic and Toxic Myelopathies

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