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Recording Brain Electromagnetic Activity During the Administration of the Gaseous Anesthetic Agents Xenon and Nitrous Oxide in Healthy Volunteers

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Inhaled nitrous oxide-induced functional B₁₂ deficiency.

Yorissa Padayachee¹, Chris Richards², Owen Morgan²

¹Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK yorissap5@gmail.com.

BMJ Case Reports

|March 16, 2021

Summary

Recreational nitrous oxide (N₂O) misuse can cause spinal cord damage by depleting vitamin B12. Young users experiencing neurological symptoms like numbness and weakness should seek medical advice and stop N₂O use.

Keywords:

drug misuse (including addiction)drugs misuse (including addiction)spinal cord vitamins and supplements

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Published on: November 25, 2014

Area of Science:

Neurology
Toxicology

Background:

Recreational nitrous oxide (N₂O) use is prevalent among young individuals due to accessibility and low cost.
Poor awareness exists regarding the severe neurological adverse effects associated with N₂O misuse.
N₂O inhalation can lead to spinal cord degeneration by interfering with DNA synthesis via cobalamin (vitamin B12) inactivation.

Observation:

A 19-year-old male presented with a 4-week history of progressive paresthesia in extremities and 2 weeks of limb weakness.
Clinical examination revealed an ataxic gait, reduced grip and ankle strength, and impaired lower limb sensation.
MRI confirmed myelopathy in the cervical and thoracic spinal cord.

Findings:

The patient reported recent recreational nitrous oxide (N₂O) inhalation.
Neurological symptoms significantly improved after cessation of N₂O use and initiation of B vitamin supplementation.
The case highlights a direct correlation between N₂O misuse and subacute combined degeneration of the spinal cord.

Implications:

Urgent need for public health education on the risks of recreational N₂O.
Clinicians should consider N₂O toxicity in young patients presenting with myelopathy symptoms.
Prompt diagnosis and management, including N₂O cessation and B12 repletion, are crucial for recovery.