Serum copper decrease and cerebellar atrophy in patients with nitrous oxide-induced subacute combined degeneration: two cases report

Abstract Background Subacute combined degeneration (SCD) is a neurological complication commonly associated with vitamin B12 deficiency. It can result from nitrous oxide (N2O) abuse and cause neuropsychiatric symptoms. However, there has been no literature regarding alterations of serum copper and cerebellum in SCD patients. Case presentation We reported two cases of young SCD patients with histories of N2O abuse. In these cases, elevated homocysteine, macrocytic anemia, spinal cord abnormalities, and peripheral nerve injuries were detected. In addition, decreased serum copper level and cerebellar atrophy were reported for the first time. The patients’ symptoms improved after withdrawal of N2O exposure and vitamin B12 supplements. Conclusion We reported two SCD cases with serum copper alteration and cerebellar atrophy after N2O abuse for the first time. These might be crucial complements to the diagnosis of SCD.

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

Neurographics ◽

10.3174/ng.2000063 ◽

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.

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Subacute Combined Degeneration of the Spinal Cord due to Different Etiologies and Improvement of MRI Findings

Case Reports in Neurological Medicine ◽

10.1155/2013/159649 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Azize Esra Gürsoy ◽

Mehmet Kolukısa ◽

Gülsen Babacan-Yıldız ◽

Arif Çelebi

Keyword(s):

Spinal Cord ◽

Nitrous Oxide ◽

Vitamin B12 ◽

Neurological Complication ◽

Vitamin B12 Deficiency ◽

Vegetarian Diet ◽

Mri Findings ◽

Subacute Combined Degeneration ◽

B12 Deficiency ◽

Reversible Condition

Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.

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

Neuromuscular Diseases ◽

10.17650/2222-8721-2020-10-3-49-62 ◽

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).

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One month of nitrous oxide abuse causing acute vitamin B12 deficiency with severe neuropsychiatric symptoms

BMJ Case Reports ◽

10.1136/bcr-2018-228001 ◽

2019 ◽

Vol 12 (2) ◽

pp. bcr-2018-228001 ◽

Cited By ~ 1

Author(s):

Michael S Lundin ◽

John Cherian ◽

Michael Nyika Andrew ◽

Richa Tikaria

Keyword(s):

Nitrous Oxide ◽

Neuropsychiatric Symptoms ◽

Vitamin B12 Deficiency ◽

Vitamin B ◽

Lower Extremity Weakness ◽

Studying Abroad ◽

The Usa ◽

B12 Deficiency ◽

Whipped Cream ◽

Brain And Spinal Cord

A 21-year-old university student studying abroad in the USA presented to the emergency department with double vision, lower extremity weakness with difficulty ambulating and other neuropsychiatric symptoms. MRI of the brain and spinal cord were normal. Vitamin B12 was 78 pg/mL (58 pmol/L, reference 211–911 pg/mL). The patient had been using nitrous oxide capsules used for whipped cream recharging, which she obtained from other students, a few times daily for a month for the purpose of anxiety relief. The patient was not a vegan or vegetarian. The patient was treated with intramuscular vitamin B12 repletion with partial resolution of neurologic symptoms and discharged on vitamin B12 supplementation.

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The dangers of recreational inhalation of nitrous oxide

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0322 ◽

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.

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Serum Copper Level and Polycystic Ovarian Syndrome: A Meta-Analysis

Gynecologic and Obstetric Investigation ◽

10.1159/000516518 ◽

2021 ◽

pp. 1-8

Author(s):

Qingtao Jiang ◽

Feng Zhang ◽

Lei Han ◽

Baoli Zhu ◽

Xin Liu

Keyword(s):

Large Scale ◽

Polycystic Ovarian Syndrome ◽

Meta Analysis ◽

Serum Copper ◽

Copper Level ◽

Serum Copper Level ◽

Copper Status ◽

Plasma Copper ◽

Mean Differences ◽

Ovarian Syndrome

Introduction: The association of serum copper with polycystic ovarian syndrome (PCOS) has been studied for years, but no definite conclusion is drawn. Therefore, we conducted a meta-analysis to investigate serum copper concentrations in PCOS subjects compared with healthy controls. Methods: Electronic search was performed in PubMed, Google Scholar, and Scopus up to June 30, 2020, without any restriction. Standardized mean differences (SMDs) with corresponding 95% CIs in serum copper levels were employed with random-effects model. I2 was applied to evaluate heterogeneity among studies. Results: Nine studies, measuring plasma copper levels in 1,168 PCOS patients and 1,106 controls, were included. Pooled effect size suggested serum copper level was significantly higher in women with PCOS (SMD = 0.51 μg/mL, 95% CI = [0.30, 0.72], p < 0.0001). The overall heterogeneity was not connected with subgroups of the country, but derived from the opposite result of 1 study. Conclusion: Our research generally indicated circulating copper level in PCOS sufferers was significantly higher than normal controls. Large-scale studies are still needed to elucidate the clear relation between copper status and etiology of PCOS.

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Serum Copper with Coronary Artery Disease in Male and its Relation with Lipid Profile

Bangladesh Journal of Physiology and Pharmacology ◽

10.3329/bjpp.v24i1.5730 ◽

1970 ◽

pp. 7-9

Author(s):

Sifat Jubaira ◽

Forhadul Haque Mollah ◽

Tahrim Mehdi ◽

M Iqbal Arslan

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Lipid Profile ◽

Density Lipoprotein ◽

Serum Copper ◽

Copper Level ◽

Serum Copper Level ◽

Artery Disease

The study was designed to explore serum copper as a risk factor for coronary artery disease (CAD). In this case-control study 30 healthy controls and 60 diagnosed cases of acute myocardial infarction (AMI) were enrolled. Serum copper concentration and serum lipid profile were measured in all study subjects. Serum copper level was significantly higher in AMI as compared to controls. The concentrations of serum TC, TG, LDL-C level were found to be significantly higher in cases as compared to controls. The concentration serum HDL-C was found to be significantly lower in cases as compared to controls. CAD leads to raised serum copper level and it has positive correlation with TC, TG and LDL-C but negative correlation with HDL-C in males.Keywords: Coronary artery disease; serum copper; acute myocardial infarction; total cholesterol; triglyceride; low density lipoprotein cholesterol. DOI: 10.3329/bjpp.v24i1.5730Bangladesh J Physiol Pharmacol 2008; 24(1&2) : 7-9

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The Level of Serum Pepsinogen in Diagnosing and Evaluating the Severity of Subacute Combined Degeneration Due to Vitamin B12 Deficiency

Frontiers in Neurology ◽

10.3389/fneur.2021.604523 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaoyan Chen ◽

Rong Wang ◽

Xusheng Huang ◽

Fei Yang ◽

Shengyuan Yu

Keyword(s):

Vitamin B12 ◽

Neurological Complication ◽

Vitamin B12 Deficiency ◽

Inverse Correlation ◽

Cobalamin Deficiency ◽

Serum Pepsinogen ◽

Roc Curve Analysis ◽

Subacute Combined Degeneration ◽

B12 Deficiency ◽

Autoimmune Atrophic Gastritis

Subacute combined degeneration (SCD) is a neurological complication of cobalamin deficiency, which is usually caused by chronic autoimmune atrophic gastritis. Serum pepsinogen 1 and the ratio of pepsinogen 1/pepsinogen 2 (PG1/2) can reflect the severity of gastric atrophy.Objective: This work aims to investigate whether decreased serum PG1 and PG1/2 ratio are helpful in diagnosing SCD and reflecting the severity of SCD.Methods: We retrospectively analyzed the clinical and laboratory tests of 65 cases of SCD due to vitamin B12 deficiency and compared the laboratory parameters of SCD with 65 age- and sex-matched amyotrophic lateral sclerosis (ALS) patients.Results: PG1 and PG1/2 ratio were decreased in 80 and 52.3% of SCD patients, respectively. Compared to patients with PG1/2 ratio ≥3.0, patients with PG1/2 ratio <3.0 had more severe anemia, larger mean corpuscular volume (MCV), lower level of vitamin B12, higher folate and homocysteine (Hcy), more severe changes in somatosensory evoked potential (SEP), and higher rate of lesions in spinal MRI (P < 0.05). PG1 and PG1/2 ratio had inverse correlation with MCV and N20 latency in SEP examination (P < 0.05). PG1/2 ratio, RBC count, and Hcy were independent risk factors for SCD in logistic regression analyses. The ROC curve analysis revealed that the diagnostic accuracy of PG1 and PG1/2 ratio was 72.2 and 73.0%, respectively, while the cutoff values were 22.4 ng/ml and 2.43 for SCD, respectively.Conclusions: Decreased PG1 and PG1/2 ratio are helpful for the diagnosis and evaluation of the severity of SCD due to vitamin B12 deficiency.

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