scholarly journals Nitrous oxide myelopathy with functional vitamin B12deficiency

2019 ◽  
Vol 12 (2) ◽  
pp. e227439 ◽  
Author(s):  
John Williamson ◽  
Saif Huda ◽  
Dinesh Damodaran
Keyword(s):  
Nitrous Oxide ◽  
Male Patient ◽  
Neurological Complications ◽  
Vitamin B ◽  
Blood Tests ◽  
Dorsal Columns ◽  
Legal High ◽  
The Uk ◽  
Recreational Use

Recreational use of nitrous oxide as a ‘legal high’ is increasing in the UK. Physicians should be ‘street wise’ to this increasing prevalence and aware of the potential neurological complications which may result from misuse. We describe a 17-year-old male patient who presented to neurology with a severe myelopathy following prolonged recreational use of nitrous oxide. MRI demonstrated characteristic changes affecting the dorsal columns and blood tests demonstrated a ‘functional’ B12 deficiency. Clinical and radiological improvement was noted following initiation of vitamin B12 replacement.

Nitrous Oxide Abuse‐Induced Subacute Combined Degeneration: Classic Neuroimaging Findings on MRI

Neurographics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 72-74
Author(s):  
A.K. Kirsch ◽  
S.M. Allison ◽  
S.A. Kilanowski
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Mr Imaging ◽  
Young Patient ◽  
Patient Population ◽  
High Signal ◽  
Vitamin B ◽  
Subacute Combined Degeneration ◽  
Dorsal Columns ◽  
Delay In Treatment

Subacute combined degeneration is uncommonly a result of nitrous oxide abuse and presents with high signal in the dorsal columns of the spinal cord on T2-weighted MR imaging. We present a case of subacute combined degeneration in a young patient who abused nitrous oxide, which is an uncommon cause and infrequently seen in this patient population. Symptoms are often reversible with treatment of vitamin B12, and radiologists should be aware of these findings to avoid delay in treatment.

scholarly journals Just say N2O – nitrous oxide misuse: essential information for psychiatrists

2019 ◽  
Vol 26 (2) ◽  
pp. 72-81
Author(s):  
Rollo J. G. Sheldon ◽  
Michael Reid ◽  
Frederick Schon ◽  
Norman A. Poole
Keyword(s):  
Nitrous Oxide ◽  
Cognitive Impairment ◽  
Mechanism Of Action ◽  
Psychiatric Symptoms ◽  
Diagnosis And Treatment ◽  
Vitamin B ◽  
Essential Information ◽  
Principles Of Treatment ◽  
The Uk

SUMMARYNitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.

scholarly journals Neurological complications and pathogenetic therapy for chronic nitrous oxide intoxication (“laughing gas”) in nightclub visitors

2020 ◽  
Vol 10 (3) ◽  
pp. 49-62
Author(s):  
N. А. Suponeva ◽  
D. А. Grishina ◽  
D. А. Grozova ◽  
N. V. Belova ◽  
М. А. Ginzberg ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Vitamin B ◽  
Aged People ◽  
Laughing Gas ◽  
Pathogenetic Therapy ◽  
Vitamin Level ◽  
Sensory Polyneuropathy

Background. Nitrous oxide abuse (“laughing gas”, N2O) is common among young people attending nightclubs. Contrary to popular belief about the safety of N2O, in some cases neurological complications develop due to a deficiency of vitamin B12, the activity of which is blocked by N2O. Purpose of the study – to determine the typology and course of neurological disorders in a group of patients who regularly use “laughing gas”. To note the key diagnostic markers that allow verification of vitamin B12 deficiency induced by nitrous oxide consumption. To describe pathogenetic therapy features and follow-up. Materials and methods. The study included 12 patients (10 men and 2 women) aged 18 to 45 years (average age 29 years) with a diagnosis of B12-deficient myelopolyneuropathy induced by regular use of nitrous oxide. Results. The most common neurological complication of nitrous oxide abuse for more than 1 month was a generalized lesion of the peripheral nerves with acute or subacute distal symmetric sensory or sensorimotor axonal polyneuropathy. In the clinical picture, sensory complaints and disorders prevailed. Paresis developed in half of the cases. A typical neuroimaging symptom characteristic of funicular myelosis was rarely detected (16.7 %). A decrease in B12 vitamin level could most reliably be diagnosed only indirectly, by the presence of hyperhomocysteinemia (91.7 % of cases). In all cases that were followed-up, prolonged therapy with cyanocobalamin led to partial (n = 5; 62.5 %) or complete (n = 3; 37.5 %) regression of neurological symptoms. Conclusion. Caution regarding the use of nitrous oxide should be in all cases of predominantly sensory polyneuropathy with acute or subacute development in young and middle-aged people. A thorough history taking (targeted survey on the fact of nitrous oxide consumption) and diagnostics (testing the level of homocysteine, if possible methylmalonic acid) allow you to not miss a deficiency of vitamin B12, the treatment of the consequences of which with timely verification and adequate correction is quite effective. It is recommended that the level of homocysteine in the blood to be regularly monitored during the treatment (in order to achieve its normalization).

scholarly journals Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter

2021 ◽  
pp. 20200179
Author(s):  
Pia F P Charters ◽  
Hamish Duncan Morrison ◽  
Jonathan Witherick ◽  
Susan King
Keyword(s):  
Nitrous Oxide ◽  
Normal Range ◽  
Subacute Combined Degeneration ◽  
Over The Counter ◽  
Aerosol Spray ◽  
Household Item ◽  
Dorsal Columns ◽  
B12 Deficiency ◽  
Hands And Feet ◽  
Recreational Use

Nitrous oxide (N2O) has several traditional uses as a surgical and dental anaesthetic, as well as in aerosol spray propellants. It is the combination of analgesic and euphoric qualities coupled with accessibility as an over-the-counter household item that lends N2O to recreational use. Despite increasing evidence that prolonged use of N2O both medically and as a drug of abuse can cause disabling neurological side-effects, it remains widely used. We present the case of an 18-year-old male who was diagnosed with subacute combined degeneration of the cord (SCDC) secondary to acute, heavy recreational use of N2O. The patient presented with progressive paraesthesia affecting his hands and feet associated with distal weakness. MRI of the cervical spine revealed symmetric bilateral high T2 signal within the dorsal columns extending from the level of C2 to T2 with the inverted ‘V’ sign on axial T2-weighted slices indicative of SCDC. Although vitamin B12 levels were within normal range, marked elevation of methylmalonic acid and homocysteine support the diagnosis of B12 inactivation and functional B12 deficiency, which fully resolved with treatment.

The dangers of recreational inhalation of nitrous oxide

2021 ◽  
pp. 1-8
Author(s):  
Joshua Wong ◽  
Thevarajah Viyasar ◽  
Benjamin Layton ◽  
Joshua Lauder
Keyword(s):  
Nitrous Oxide ◽  
Psychosocial Interventions ◽  
Complete Recovery ◽  
Clinical Findings ◽  
Vitamin B ◽  
Alveolar Pressure ◽  
Subacute Combined Degeneration ◽  
System A ◽  
Laughing Gas ◽  
The Uk

Nitrous oxide, also known as ‘laughing gas’, is one of the most widely used recreational drugs among teenagers in the UK. Copious inhalation of nitrous oxide may increase intra-alveolar pressure, resulting in barotrauma secondary to alveolar rupture. Pneumomediastinum and subcutaneous emphysema are common clinical findings in nitrous oxide-associated barotrauma. Prolonged nitrous oxide misuse may inactivate vitamin B12 through the alteration of its metabolism, causing demyelination of the central and peripheral nervous system. A spectrum of neurological manifestations has been reported, including peripheral neuropathy, myelopathy and subacute combined degeneration of the spinal cord. Medical therapies and psychosocial interventions aiming at nitrous oxide cessation are important treatment steps to achieve partial or complete recovery from the adverse effects associated with inhalation of nitrous oxide.

scholarly journals 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Nathan ◽  
N Hanna ◽  
A Rashid ◽  
S Patel ◽  
Y Phuah ◽  
...  
Keyword(s):  
Blood Test ◽  
Open Surgery ◽  
Clinical Judgement ◽  
Robotic Assisted ◽  
Blood Tests ◽  
Routine Blood ◽  
Operative Complications ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Uk ◽  
Post Operative Complications

Abstract Introduction Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines. Method 1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients. Results 16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion. Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%). Conclusions Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.

A review of contemporary inhalation sedation guidelines and regulations related to treating children

2017 ◽  
Vol 8 (3) ◽  
pp. 112-118 ◽  
Author(s):  
S Rajan ◽  
DJ Manton ◽  
N Bhujel
Keyword(s):  
Nitrous Oxide ◽  
General Anaesthesia ◽  
Paediatric Dentistry ◽  
Safe Practice ◽  
Global Trends ◽  
Inhalation Sedation ◽  
Dental Procedures ◽  
The Us ◽  
The Uk

Inhalation sedation (IS) with nitrous oxide (N2O) is classified as minimal sedation. In paediatric dentistry, IS works well for mildly anxious but potentially cooperative children, reducing the need for general anaesthesia for simple dental procedures. We review contemporary guidelines relating to ISN2O in Australasia, the UK, Europe and the US. As this is a multispecialty area, with differences in laws, regulations, guidance and governance from country to country, this review aims to illuminate global trends and assist with the designing of local regulations for the safe practice of ISN2O.

scholarly journals Recommendation of Repeated Ammonia Tests for Intrahepatic Portal-Systemic Shunt Without Cirrhosis in Elderly Patients With Psychiatric Symptoms

2017 ◽  
Vol 8 ◽  
pp. 117906601769359
Author(s):  
Michiaki Abe ◽  
Temma Soga ◽  
Nobuya Obana ◽  
Kazumasa Seiji ◽  
Masao Tabata ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Elderly Patients ◽  
Psychiatric Disorder ◽  
Male Patient ◽  
Psychiatric Symptoms ◽  
Blood Ammonia ◽  
Elderly Male ◽  
Blood Tests ◽  
Portal Systemic Shunt

We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. The contrast computed tomography of the abdomen revealed a congenital type of IPSSwoC. As blood ammonia levels are inconstant, repeated blood tests are recommended when this disease is suspected in elderly patients with psychiatric symptoms.

scholarly journals Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

2018 ◽  
Vol 104 (6) ◽  
pp. 552-557 ◽  
Author(s):  
Seilesh Kadambari ◽  
Serena Braccio ◽  
Sonia Ribeiro ◽  
David J Allen ◽  
Richard Pebody ◽  
...  
Keyword(s):  
White Cell Count ◽  
Clinical Information ◽  
Neurological Complications ◽  
Surveillance Period ◽  
Live Births ◽  
Young Infants ◽  
Hearing Test ◽  
Surveillance Unit ◽  
The Uk

ObjectivesThis study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.Participants, design and settingProspective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.Main outcome measuresTo describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.ResultsDuring the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.ConclusionThe incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

scholarly journals Dietary intake of folate, vitamin B6, vitamin B12 and riboflavin and risk of Parkinson's disease: a case–control study in Japan

2010 ◽  
Vol 104 (5) ◽  
pp. 757-764 ◽  
Author(s):  
Kentaro Murakami ◽  
Yoshihiro Miyake ◽  
Satoshi Sasaki ◽  
Keiko Tanaka ◽  
Wakaba Fukushima ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dietary Intake ◽  
Case Control Study ◽  
Case Control ◽  
B Vitamins ◽  
Vitamin B ◽  
Increased Risk ◽  
The Uk ◽  
Control Study

Increased homocysteine levels might accelerate dopaminergic cell death in Parkinson's disease (PD) through neurotoxic effects; thus, increasing intake of B vitamins involved in the regulation of homocysteine metabolism might decrease the risk of PD through decreasing plasma homocysteine. However, epidemiological evidence for the association of dietary B vitamins with PD is sparse, particularly in non-Western populations. We conducted a hospital-based case–control study in Japan to examine associations between dietary intake of folate, vitamin B6, vitamin B12 and riboflavin and the risk of PD. Patients with PD diagnosed using the UK PD Society Brain Bank criteria (n 249) and controls without neurodegenerative diseases (n 368) were recruited. Dietary intake during the preceding month was assessed at the time of study recruitment using a validated, self-administered, semi-quantitative, comprehensive diet history questionnaire. After adjustment for potential dietary and non-dietary confounding factors, intake of folate, vitamin B12 and riboflavin was not associated with the risk of PD (P for trend = 0·87, 0·70 and 0·11, respectively). However, low intake of vitamin B6 was associated with an increased risk of PD, independent of potential dietary and non-dietary confounders. Multivariate OR (95 % CI) for PD in the first, second, third and fourth quartiles of vitamin B6 were 1 (reference), 0·56 (0·33, 0·94), 0·69 (0·38, 1·25) and 0·48 (0·23, 0·99), respectively (P for trend = 0·10). In conclusion, in the present case–control study in Japan, low intake of vitamin B6, but not of folate, vitamin B12 or riboflavin, was independently associated with an increased risk of PD.

Sign in / Sign up

Export Citation Format

Share Document