Lan Shih-Yun, Kuo Cheng-Yen, Chou Cheng-Che, Kong Shu-Sing, Hung Po-Cheng, Tsai Hsin-Yu, Chen Yi-Ching, Lin Jainn-Jim, Chou I-Jun, Lin Kuang-Lin
Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan.
Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Brain Dev. 2019 May;41(5):428-435. doi: 10.1016/j.braindev.2018.12.003. Epub 2019 Jan 2.
Nitrous oxide (NO) is a commonly used inhaled anesthetic in outpatient dental procedures. However, the increasing recreational use of NO may result in vitamin B deficiency-related neurologic and psychiatric symptoms. The aim of this study was to demonstrate the clinical features of chronic NO abuse in pediatric patients.
Patients under 20 years of age who were diagnosed with NO-induced subacute combined degeneration of the spinal cord from 2012 to 2018 were enrolled in this study. Clinical presentations, laboratory, imaging, ancillary studies, treatments and outcomes were analyzed.
Nine patients were included, all of whom presented with symptoms of myeloneuropathy including limb numbness, limb weakness or unsteady gait. Six patients had low or low-normal vitamin B (cyanocobalamin) levels. Eight patients had evidence of subacute combined degeneration of the spinal cord via neuroimaging studies. All of the patients received vitamin B supplementation as treatment. All had full recovery of muscle power within 2 months. Five patients had persistent sensory deficits.
Chronic NO abuse can cause permanent neurological damage if not treated promptly. Clinical staff should be aware of the various presentations of neurotoxicity related to NO abuse.
一氧化二氮（N₂O）是门诊牙科手术中常用的吸入性麻醉剂。然而，N₂O越来越多地被用于娱乐用途，这可能会导致与维生素B缺乏相关的神经和精神症状。本研究的目的是阐明儿科患者慢性滥用N₂O的临床特征。
纳入2012年至2018年期间诊断为N₂O诱导的脊髓亚急性联合变性的20岁以下患者。对临床表现、实验室检查、影像学检查、辅助检查、治疗及预后进行分析。
共纳入9例患者，所有患者均出现脊髓神经病症状，包括肢体麻木、肢体无力或步态不稳。6例患者的维生素B（钴胺素）水平较低或略低于正常水平。8例患者通过神经影像学检查证实存在脊髓亚急性联合变性。所有患者均接受维生素B补充治疗。所有患者在2个月内肌肉力量完全恢复。5例患者存在持续性感觉障碍。
慢性滥用N₂O若不及时治疗可导致永久性神经损伤。临床工作人员应了解与滥用N₂O相关的神经毒性的各种表现。
