Nitrous Oxide-Associated Myelopolyneuropathy-A Case Series

Nitrous oxide is a multipurpose gas that has recently gained attention because of its use as a recreational drug and the associated neurological complications of abuse.

Seven patients were included, and clinical, electrodiagnostic, imaging, and serological data were retrospectively analyzed.

All patients presented with various degrees of sensory impairment, gait disorder, muscle weakness, or ataxia, mainly involving the lower limbs. Electrodiagnostic studies showed a predominantly motor neuropathy, with axonal, demyelinating, or mixed features. Spinal magnetic resonance imaging showed posterior cord lesions in cervical regions, with 2 patients presenting concomitant thoracic cord lesions. Homocysteine levels were elevated in all patients.

Nitrous oxide abuse is known to be connected to the development of both polyneuropathy and myelopathy. Better understanding of the physiological, clinical, and paraclinical aspects of this pathology is needed to make a correct differential diagnosis and conduct and adequate treatment.