Wang Y Y, Wang R B, Hong W, Jiao J S, Peng D T, Liu Z J, Tian Z H, Jin M, Dong M R, Duan X H, Liu L, Sun Q, Sun S J, Wang L
The Second Health and Medical Department, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Apr 18;51(2):288-292. doi: 10.19723/j.issn.1671-167X.2019.02.017.
To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (NO).
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 NO, clinical features, blood examination, electrophysiological examination, spinal magnetic resonance imaging and therapeutic efficacy profiles.
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 NO 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 "crescent", 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.
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.
分析一氧化二氮（NO）所致神经损伤的临床及影像学特征。
回顾性分析2015年10月至2018年2月中日友好医院神经内科收治的10例患者的人口学资料、吸入NO史、临床特征、血液检查、电生理检查、脊髓磁共振成像及治疗效果等情况。
男女比例为4:6，发病年龄为17～26岁[平均年龄：（20.80±3.12）岁]。从吸入NO至发病时间为1个月至1年[平均时间：（6.95±4.19）个月]。所有患者均有肢体瘫痪，9例患者有肢体麻木，3例患者有莱尔米特征阳性，4例患者有大小便障碍。血液检查显示2例患者贫血，1例为巨细胞贫血，1例为小细胞低色素性贫血。3例患者在外院曾接受维生素B12治疗，另外7例患者同型半胱氨酸水平异常升高。电生理检查显示9例患者感觉和运动神经受累，1例患者仅运动神经受累。下肢病变严重程度明显重于上肢。脊髓磁共振成像显示所有患者颈髓均有长节段病变，3例患者胸髓有长节段病变，2例患者脊髓肿胀。6例患者横轴位呈“倒V型”T2高信号，1例为“新月型”，3例为“八字型”。这10例患者在停止吸入一氧化二氮、积极补充大剂量维生素B12并早期进行康复锻炼后症状均有不同程度缓解。
一氧化二氮所致脊髓病表现为肢体瘫痪和麻木。影像学上颈髓损伤常见，可伴有胸髓损伤。横轴位以“倒V型”多见。大剂量维生素B12治疗有效。
