Yoon Sojung, Kim Dong Yu, Chu Min Kyung
Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
BMC Neurol. 2025 May 26;25(1):220. doi: 10.1186/s12883-025-04237-x.
The abuse of nitrous oxide (NO) as a recreational drug has become a growing concern, manifesting in various medical complications. Here, we report the first Korean case of cerebral venous thrombosis (CVT) and pulmonary thromboembolism (PTE) caused by nitrous oxide abuse and anti-phospholipid syndrome.
A 24-year-old Korean man studying abroad in the USA presented to the emergency department with altered sensorium, gait disturbance, and involuntary leg movements. His history revealed escalating nitrous oxide inhalation from occasional use to daily intake of 100 balloons over six months. The patient's symptoms were initially attributed to cobalamin deficiency due to NO abuse, leading to hyperhomocysteinemia and subsequent venous thrombosis, particularly CVT and PTE. However, the presence of Lupus Anticoagulant (LA) indicated a potential autoimmune or inflammatory process contributing to thrombotic complications, complicating the diagnosis. The patient's treatment involved cobalamin supplementation, anticoagulation therapy, and addressing associated substance abuse and depression. Notably, subsequent tests revealed persistent positive LA, highlighting the complexity of the case and the multifactorial nature of NO-induced complications.
The mechanisms underlying NO-induced thrombotic complications are elucidated, primarily involving the oxidation of cobalamin to its inactive form, leading to hyperhomocysteinemia and endothelial dysfunction. The association with LA suggests a potential autoimmune or inflammatory component, adding another layer of complexity to pathophysiology. This case underscores the importance of recognizing and managing the systemic thrombotic risk associated with NO abuse. It highlights the need for heightened vigilance in diagnosing and managing associated complications, including CVT, and emphasizes the importance of comprehensive diagnostic and treatment approaches addressing both medical and psychiatric aspects. In conclusion, this case serves as a poignant reminder of the serious medical consequences of NO abuse and underscores the importance of early recognition, comprehensive management, and ongoing surveillance to mitigate its adverse effects on individual health and public well-being.
一氧化二氮（NO）作为一种消遣性药物被滥用的情况日益引起关注，这表现为各种医学并发症。在此，我们报告首例因一氧化二氮滥用和抗磷脂综合征导致的韩国人脑静脉血栓形成（CVT）和肺血栓栓塞（PTE）病例。
一名在美国留学的24岁韩国男性因意识改变、步态障碍和腿部不自主运动被送往急诊科。他的病史显示，在六个月内，一氧化二氮吸入量从偶尔使用逐渐增加到每天100个气球。患者的症状最初被归因于因一氧化二氮滥用导致的钴胺素缺乏，进而导致高同型半胱氨酸血症及随后的静脉血栓形成，尤其是CVT和PTE。然而，狼疮抗凝物（LA）的存在表明存在潜在的自身免疫或炎症过程，这导致了血栓形成并发症，使诊断变得复杂。患者的治疗包括补充钴胺素、抗凝治疗以及解决相关的药物滥用和抑郁问题。值得注意的是，后续检查显示LA持续呈阳性，凸显了该病例的复杂性以及一氧化二氮所致并发症的多因素性质。
一氧化二氮所致血栓形成并发症的潜在机制得以阐明主要涉及钴胺素氧化为无活性形式，导致高同型半胱氨酸血症和内皮功能障碍。与LA的关联提示存在潜在的自身免疫或炎症成分，这给病理生理学增加了另一层复杂性。该病例强调了认识和管理与一氧化二氮滥用相关的全身性血栓形成风险的重要性。它凸显了在诊断和管理包括CVT在内的相关并发症时提高警惕的必要性，并强调了综合诊断和治疗方法在解决医学和精神方面问题的重要性。总之，该病例强烈提醒人们一氧化二氮滥用的严重医学后果，并强调早期识别、综合管理和持续监测以减轻其对个人健康和公众福祉的不利影响的重要性。
