Acute cognitive disorder as the initial manifestation of nitrous oxide abusing: a case report


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.

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  1. 1.

    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.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Gillman MA, Lichtigfeld FJ, Harker N (2006) Psychotropic analgesic nitrous oxide for acute cocaine withdrawal in man. Int J Neurosci 116:847–857.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    van Amsterdam J, Nabben T, van den Brink W (2015) Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 73:790–796.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Stacy CB, Di Rocco A, Gould RJ (1992) Methionine in the treatment of nitrous-oxide-induced neuropathy and myeloneuropathy. J Neurol 239:401–403

    CAS  Article  Google Scholar 

  5. 5.

    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.

    Article  PubMed  Google Scholar 

  6. 6.

    Massey TH, Pickersgill TT, J. Peall K (2016) Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Rep.

  7. 7.

    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

    PubMed  Google Scholar 

  8. 8.

    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.

    Article  PubMed  Google Scholar 

  9. 9.

    El Otmani H, El Moutawakil B, Moutaouakil F et al (2007) Postoperative dementia: toxicity of nitrous oxide. Encephale 33:95–97

    Article  Google Scholar 

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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).

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Correspondence to Yanming Xu.

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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.

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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).

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  • Nitrous oxide
  • Abusing
  • Cognitive disorders