Tuan Tran Anh, Minh Duc Nguyen, Sy Than Van, Hung Trinh Minh, Cuong Tran, Anh Nguyen Quang, Luu Vu Dang, Thong Pham Minh
Department of Radiology, Bach Mai Hospital, Hanoi.
Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City.
Neurol Int. 2020 Aug 18;12(2):8652. doi: 10.4081/ni.2020.8652.
Nitrous oxide (NO) is a weak anesthetic gas that was first used in 1844 in the field of dental anesthesia. However, currently, NO is being abused for entertainment purposes in the form of NO-filled balloons, called , which can cause many adverse effects, especially nervous system injury. This study aimed to investigate the detailed clinical and subclinical features associated with NO intoxication. We retrospectively reviewed 47 patients diagnosed with NO intoxication, from May 2018 to July 2019, and collected demographic data, clinical and laboratory tests, and spinal cord magnetic resonance imaging (MRI) findings. The mean time of funky ball use was 8.8 months, with a mean use of 36.3 balls per day. All patients presented with superficial sensory disorders. Reductions in muscle strength, decreased vibration sensation, and decreased or lost tendon reflexes were the most common clinical signs of NO intoxication. Romberg sign and Lhermitte sign were observed in 39 patients (83%) and 21 patients (44.7%), respectively. Spinal cord lesions on MRI were observed in 32 patients (68.1%), which mostly presented with an inverted V sign. The total duration of NO use, the number of days of using NO per week, and the presence of Lhermitte sign (P<0.05) were significantly different between patients with and without spinal cord lesions on MRI. Serum levels of homocysteine and vitamin B12 were significantly different between the time of admission and discharge (P<0.05). Our study indicated that the was significantly associated with Spinal Cord Injuries (SCI) on MRI. According to the Receiver Operating Characteristic (ROC) curve analysis, a cutoff value of 2.5 days could predict SCI with a sensitivity of 81.3%, a specificity of 73.3%, and an area under the ROC curve (AUC) of 0.813. Changes in the serum levels of homocysteine and vitamin B12 were effective markers for the evaluation of treatment response.
一氧化二氮（NO）是一种弱麻醉气体，于1844年首次用于牙科麻醉领域。然而，目前，NO正以填充NO的气球（称为“时髦球”）的形式被滥用于娱乐目的，这可能会导致许多不良反应，尤其是神经系统损伤。本研究旨在调查与NO中毒相关的详细临床和亚临床特征。我们回顾性分析了2018年5月至2019年7月期间诊断为NO中毒的47例患者，收集了人口统计学数据、临床和实验室检查结果以及脊髓磁共振成像（MRI）结果。使用“时髦球”的平均时间为8.8个月，平均每天使用36.3个球。所有患者均出现浅感觉障碍。肌肉力量减弱、振动觉减退以及腱反射减弱或消失是NO中毒最常见的临床体征。分别有39例患者（83%）和21例患者（44.7%）出现闭目难立征和莱尔米特征。32例患者（68.1%）在MRI上观察到脊髓病变，主要表现为倒V征。在MRI上有脊髓病变和无脊髓病变的患者之间，NO的总使用时长、每周使用NO的天数以及莱尔米特征的出现情况（P<0.05）存在显著差异。入院时和出院时血清同型半胱氨酸和维生素B12水平存在显著差异（P<0.05）。我们的研究表明，“时髦球”与MRI上的脊髓损伤（SCI）显著相关。根据受试者操作特征（ROC）曲线分析，截断值为2.5天可预测SCI，灵敏度为81.3%，特异性为73.3%，ROC曲线下面积（AUC）为0.813。血清同型半胱氨酸和维生素B12水平的变化是评估治疗反应的有效指标。
