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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (2): 288-292. doi: 10.19723/j.issn.1671-167X.2019.02.017

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Clinical features of long segmental myelopathy caused by nitrous oxide

Yun-yun WANG1,Ren-bin WANG2,Wen HONG3,Jin-song JIAO2,Dan-tao PENG2,Zun-jing LIU2,Zhao-hui TIAN2,Miao JIN2,Ming-rui DONG2,Xiao-hui DUAN2,Lei LIU2,Qing SUN2,Shao-jie SUN2,Li WANG2,∆()   

  1. 1. The Second Health and Medical Department, China-Japan Friendship Hospital, Beijing 100029, China
    2. Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
    3. Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2018-10-11 Online:2019-04-18 Published:2019-04-26
  • Contact: Li WANG E-mail:WL0050685@sina.com.cn
  • Supported by:
    the National Natural Science Foundation of China(81300942);Youth Science and Technology Talents Project of China-Japan Friendship Hospital(2015-QNYC-A-05)

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Abstract:

Objective: To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (N2O).Methods: In the study, 10 patients in the Department of Neurology of China-Japan Friendship Hospital from October 2015 to February 2018 were retrospectively analyzed for the demographic data, the history of inhaled N2O, clinical features, blood examination, electrophysiolo-gical examination, spinal magnetic resonance imaging and therapeutic efficacy profiles.Results: The male-to-female ratio was 4 ∶6 and it presented with an age-of-onset 17-26 years [the average age: (20.80±3.12) years]. The time from inhaled N2O to onset was 1 month to 1 year [the average time: (6.95±4.19) months]. Paralysis in all the patients and numbness in 9 patients were the main clinical features, while positive Lhermitte’s sign in 3 patients, urinary and defecation disturbance in 4 patients were also found. Blood examination indicated anemia in 2 patients, giant cell anemia in 1 case and small cell hypochromic anemia in 1 case. 3 cases had been treated with vitamin B12 in an external hospital, and the other 7 cases had abnormal increase in homocysteine levels. Electrophysiological examinations showed sensory and motor nerve involvement in 9 patients, and motor nerve involvement in 1 patient. The severity of lower extremity lesion was significantly heavier than that of upper extremity. Spinal magnetic resonance imagings showed that long segmental lesions were present in the cervical spinal cord of all the patients, 3 cases with long segmental lesions of the thoracic cord and 2 cases with spinal cord swelling. In 6 cases, the horizontal axis had an “inverted V-type” T2 high signal, 1 case was classified as “cre-scent”, and 3 cases were “eight-shaped”. The symptoms in these 10 cases were alleviated in varying degrees after stopping the inhalation of nitrous oxide, actively supplementing high doses of vitamin B12 and doing early rehabilitation exercises.Conclusion: Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the “inverted V-type”. Treatment with high doses of vitamin B12 is effective.

Key words: Nitrous oxide, Vitamin B12, Long segmental myelopathy

CLC Number: 

  • R744.6

Table 1

The clinical features of 10 patients"

Case Mental symptoms Numbness Limb weakness Urinary dysfunction
1 Normal Both hands, hypoesthesia below T4 Double lower limbs→arms Exist
2 Irritability Both hands, legs below the knee Extremities Exist
3 Normal Extremities distal to proximal, Lhermitte’s sign(+) Extremities Normal
4 Normal Normal Double lower limbs Normal
5 Irritability Extremities distal Double feet→extremities Normal
6 Normal Extremities distal Double feet→extremities Normal
7 Hallucination Double lower limbs→hands, Lhermitte’s sign(+) Double feet→extremities Exist
8 Normal Double lower limbs→hands Double lower limbs Exist
9 Normal Extremities Extremities Normal
10 Hallucination Extremities distal, Lhermitte’s sign(+) Extremities Exist

Figure 1

The spinal MRI of case 1 showed the long segmental lesions were present in the cervical spinal cord and the horizontal axis had an“inverted V-type”T2 high signal"

Figure 2

Before treatment, the cervical spinal cord in case 2 was thickening and swelling and the horizontal axis had an “crescent-like” T2 high signal"

Figure 3

The spinal MRI of case 3 showed the axial lesions were an “eight-shaped” sign"

Figure 4

After 2 months of treatment, swelling of the cervical spinal cord disappeared and the axial position showed an “inverted V-type” T2 high signal in case 2"

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