Abstract
Nitrous oxide (N2O) is a colorless, odorless gas used as an anesthetic and analgesic. It is also abused as a recreational drug, and such abuse is associated with neurological disorders and psychiatric complications such as myelopathy and, rarely, cognitive impairment. Its abuse has not been associated with acute cognitive decline. Here, we report a young girl who presented with acute cognitive impairment after excessive recreational inhalation of nitrous oxide and who recovered completely after vitamin B12 supplementation. We conclude that nitrous oxide abuse can cause acute cognitive impairment, and that this diagnosis should be considered if a patient initially presents with acute cognitive decline.
Similar content being viewed by others
References
Nagele P, Duma A, Kopec M, Gebara MA, Parsoei A, Walker M, Janski A, Panagopoulos VN, Cristancho P, Miller JP, Zorumski CF, Conway CR (2015) Nitrous oxide for treatment-resistant major depression: a proof-of-concept trial. Biol Psychiatry 78:10–18. https://doi.org/10.1016/j.biopsych.2014.11.016
Gillman MA, Lichtigfeld FJ, Harker N (2006) Psychotropic analgesic nitrous oxide for acute cocaine withdrawal in man. Int J Neurosci 116:847–857. https://doi.org/10.1080/00207450600754038
van Amsterdam J, Nabben T, van den Brink W (2015) Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 73:790–796. https://doi.org/10.1016/j.yrtph.2015.10.017
Stacy CB, Di Rocco A, Gould RJ (1992) Methionine in the treatment of nitrous-oxide-induced neuropathy and myeloneuropathy. J Neurol 239:401–403
Garakani A, Jaffe RJ, Savla D, Welch AK, Protin CA, Bryson EO, McDowell D (2016) Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 25:358–369. https://doi.org/10.1111/ajad.12372
Massey TH, Pickersgill TT, J. Peall K (2016) Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Rep. https://doi.org/10.1136/bcr-2016-215728
Jakovljevic M, Vidmar G, Mekjavic IB (2012) Psychomotor function during mild narcosis induced by subanesthetic level of nitrous oxide: individual susceptibility beyond gender effect. Undersea Hyperb Med 39:1067–1074
Dreyfus E, Tramoni E, Lehucher-Michel MP (2008) Persistent cognitive functioning deficits in operating rooms: two cases. Int Arch Occup Environ Health 82:125–130. https://doi.org/10.1007/s00420-008-0302-8
El Otmani H, El Moutawakil B, Moutaouakil F et al (2007) Postoperative dementia: toxicity of nitrous oxide. Encephale 33:95–97
Funding
This report supported by the Resource Collection and Standardized Diagnosis and Treatment Platform for Neurogenetic and Neurodegeneration Disease, Sichuan Science and Technology Department Platform Construction Project (19PTDJ0042).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The informed consent was obtained from the patient and there was no potential conflict of interest in it. Meanwhile, it was not a research involving human participants and/or animals.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shen, Q., Lu, H., Wang, H. et al. Acute cognitive disorder as the initial manifestation of nitrous oxide abusing: a case report. Neurol Sci 42, 755–756 (2021). https://doi.org/10.1007/s10072-019-04183-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-019-04183-w