一氧化二氮(N2O)滥用导致的脊髓严重亚急性合并变性:一个病例系列。

Q2 Medicine
Lucas C Adam, Anuschka Grobelny, Katrin Hahn, Heinrich J Audebert, Patricia Krause, Christiana Franke, Klemens Ruprecht
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引用次数: 0

摘要

目的:描述7例严重n2o诱导的脊髓亚急性合并变性(SACD)患者的人口学、临床、实验室和影像学表现以及临床病程。方法:回顾性研究,前瞻性随访2014 - 2024年在单一中心就诊的与N2O滥用相关的SACD患者。结果:7例患者(女1例,男6例)的中位年龄(范围)为24岁(18-33岁)。发病前,患者每天消耗N2O的中位(范围)为12(3-20)周,平均(SD;范围)吸入剂量2376.7 (2872.7;每天160-9000)g N2O。临床表现包括感觉异常、腿部麻痹和步态障碍。所有患者在t2加权脊柱mri上都表现出从C1到T10后柱的特征性信号改变。电生理学显示除一名患者外,所有患者均有多发性神经病。其中4名患者维生素B12水平下降,但3名患者正常。所有患者的甲基丙二酸水平均升高。虽然中位数(四分位间距[IQR])改进后的Rankin量表得分从基线时的3.0(3.0-4.0)提高到1.0 (1.0-2.0);p结论:滥用N2O超过几周可导致严重的SACD。脊柱MRI特征性表现和甲基丙二酸水平升高支持诊断,而正常维生素B12水平不排除n20诱导的SACD。虽然在停止N2O滥用和维生素B12补充后有一些临床改善,但残留的缺陷仍然存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Severe subacute combined degeneration of the spinal cord resulting from nitrous oxide (N2O) abuse: a case series.

Objective: To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD).

Methods: Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024.

Results: The median age (range) of the seven patients (one woman, six men) was 24 (18-33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160-9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0-4.0) at baseline to 1.0 (1.0-2.0; p < 0.05, Wilcoxon matched-pairs signed-rank test) at follow-up after the start of vitamin B12 supplementation, all five patients who could be examined on follow-up exhibited persistent deficits on the last follow-up assessment at a median (range) of 5 (3-116) months after disease onset.

Conclusions: N2O abuse over a few weeks can lead to severe SACD. The diagnosis is supported by characteristic findings on spinal MRI and elevated methylmalonic acid levels, while normal vitamin B12 levels do not rule out N2O-induced SACD. Although there was some clinical improvement upon cessation of N2O abuse and vitamin B12 supplementation, residual deficits persisted.

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CiteScore
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