Woodlands Health, Singapore international training fellow, Guys and St Thomas' NHS Foundation Trust, London, UK
Guys and St Thomas' NHS Foundation Trust, London, UK.
Clin Med (Lond). 2023 Mar;23(2):170-172. doi: 10.7861/clinmed.2022-0516.
A 27-year-old man presented with altered mental status and unilateral right lower limb swelling. Brain imaging and cerebrospinal fluid analysis were unremarkable. He reported history of nitrous oxide misuse after he recovered from his delirium. The diagnosis of drug induced psychosis was made. The right lower limb swelling was found to be due to extensive deep vein thrombosis. In another case, a 21-year-old woman presented with headache, vomiting and dipoplia. Brain imaging showed extensive cerebral venous sinus thrombosis. She also misused nitrous oxide. Both cases had low-normal vitamin B12 and elevated methylmalonic acid, consistent with nitrous oxide misuse. The woman was found to have elevated homocysteine because of functional vitamin B12 deficiency. Homocysteine was not measured in the man. Raised homocysteine is associated with increased thrombosis risk. Fourteen cases of nitrous oxide misuse associated arterial and venous thrombosis have been reported. These two cases highlighted the importance of inquiring about recreational drug use in young patients who presented with apparently unprovoked venous thromboembolism.
一名 27 岁男子因精神状态改变和单侧右下肢体肿胀就诊。脑部影像学和脑脊液分析均无明显异常。他在从谵妄中恢复后报告了滥用笑气的病史。诊断为药物引起的精神病。右下肢体肿胀被发现是由于广泛的深静脉血栓形成。另一个病例，一名 21 岁女性因头痛、呕吐和复视就诊。脑部影像学显示广泛的脑静脉窦血栓形成。她也滥用了笑气。这两个病例的维生素 B12 水平正常偏低，甲基丙二酸水平升高，与笑气滥用一致。该女性因功能性维生素 B12 缺乏而发现同型半胱氨酸升高。该男性未检测同型半胱氨酸。同型半胱氨酸升高与血栓形成风险增加有关。已有 14 例与笑气滥用相关的动脉和静脉血栓形成病例报告。这两个病例强调了在出现明显无诱因静脉血栓栓塞的年轻患者中询问消遣性药物使用情况的重要性。
