Co-Occurring Subacute Combined Degeneration and Guillain-Barré Syndrome Resulting From Nitrous Oxide Abuse: A Case Report.
Kristen Strom, Ateaya Lima, Vahideh Tabarzadi
Cureus December 1, 2022 DOI: 10.7759/cureus.32756 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 23-year-old female with nitrous oxide abuse |
| Interventions | Vitamin B12 injections plasmapheresis gabapentin escitalopram trazodone hydroxyzine melatonin |
| Topics | Addiction Anxiety |
| Keywords | Adjustment disorder Case report Guillain-barre syndrome Nitrous oxide Subacute combined degeneration Whippets |
| Key findings | A 23-year-old female with N2O abuse presented with concurrent subacute combined degeneration and Guillain-Barré syndrome, and improved with vitamin B12 injections and plasmapheresis. |
Abstract
Growing in prevalence as a recreational drug of abuse across a broad scope of people, nitrous oxide (N2O) has proven to be a public health concern. Side effects of its abuse have a great degree of variation among people ranging from neurologic, psychiatric, and medical symptoms. We present a rare case of a 23-year-old female with a history of N2O abuse, who presented with symptoms of both subacute combined degeneration syndrome (SCD) and Guillain-Barré syndrome (GBS). She presented with three weeks history of progressive bilateral lower extremity weakness, burning and tingling sensation, difficulty walking, and falls. This patient underwent an extensive medical workup upon hospitalization. Notable findings of the magnetic resonance imaging (MRI) of her cervical spine showed an abnormal cervical cord signal intensity pattern typical for vitamin B12 deficiency and her lumbar puncture showed albuminocytological dissociation, which confirmed the diagnosis of GBS. For these conditions, this patient was successfully treated with weekly vitamin B12 injections and five treatments of plasmapheresis. Her condition was additionally complicated by worsening anxiety and depression, which were treated with gabapentin, escitalopram, trazodone, hydroxyzine, and melatonin. She demonstrated great clinical improvement with almost complete resolution of her symptoms at the time of her hospital discharge. This case highlights the easy accessibility, addiction potential, and adverse consequences related to N2O abuse.
Comparable studies
Other case reports and case series on anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Persistent Palinopsia Following Ingestion of Lysergic Acid Diethylamide (LSD) Patients who developed persistent palinopsia after LSD ingestion | 1996 | Case series | n = 3 |
| Cannabis‐induced Koro in Americans American men aged 22-26 with years of cannabis experience who reported negative... | 2001 | Case series | n = 3 |
| Psilocybin and Obsessive Compulsive Disorder Individual with Obsessive Compulsive Disorder | 2014 | Case study | n = 1 |
| LSD-Like Panic From Risperidone in Post-LSD Visual Disorder Patients with hallucinogen-persisting perception disorder (HPPD) | 1996 | Case study | n = 3 |
| Ketamine-Enhanced Psychotherapy: Preliminary Clinical Observations on its Effects in Treating Death Anxiety Terminally-ill people suffering death anxiety | 2007 | Review and case study | n = 2 |
Citations in the library
Cites 3
- Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. Journal of Psychopharmacology April 2016
- Psychiatric comorbidities in a young man with subacute myelopathy induced by abusive nitrous oxide consumption: a case report. Substance Abuse and Rehabilitation 2016
- Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis. Journal of Medical Toxicology June 2006