scholarly journals Nitrous oxide‐related neurological disorders: Clinical, laboratory, neuroimaging, and electrophysiological findings

2021 ◽  
Author(s):  
Jiwei Jiang ◽  
Xiuli Shang ◽  
Xiaoting Wang ◽  
Hanze Chen ◽  
Wenyi Li ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Disorders ◽  
Clinical Laboratory ◽  
Electrophysiological Findings

scholarly journals Mitochondrial Strokes: Diagnostic Challenges and Chameleons

Genes ◽  
2021 ◽  
Vol 12 (10) ◽  
pp. 1643
Author(s):  
Chiara Pizzamiglio ◽  
Enrico Bugiardini ◽  
William L. Macken ◽  
Cathy E. Woodward ◽  
Michael G. Hanna ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Neurological Disorders ◽  
Clinical Laboratory ◽  
Positive Family History ◽  
Autoimmune Encephalitis ◽  
Brain Regions ◽  
Imaging Features ◽  
Cns Vasculitis ◽  
Appropriate Treatment ◽  
Mitochondrial Pathology

Mitochondrial stroke-like episodes (SLEs) are a hallmark of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). They should be suspected in anyone with an acute/subacute onset of focal neurological symptoms at any age and are usually driven by seizures. Suggestive features of an underlying mitochondrial pathology include evolving MRI lesions, often originating within the posterior brain regions, the presence of multisystemic involvement, including diabetes, deafness, or cardiomyopathy, and a positive family history. The diagnosis of MELAS has important implications for those affected and their relatives, given it enables early initiation of appropriate treatment and genetic counselling. However, the diagnosis is frequently challenging, particularly during the acute phase of an event. We describe four cases of mitochondrial strokes to highlight the considerable overlap that exists with other neurological disorders, including viral and autoimmune encephalitis, ischemic stroke, and central nervous system (CNS) vasculitis, and discuss the clinical, laboratory, and imaging features that can help distinguish MELAS from these differential diagnoses.

scholarly journals COVID-19 and posterior reversible encephalopathy syndrome: A case report

2020 ◽  
pp. 10.1212/CPJ.0000000000000904
Author(s):  
Fabio Noro ◽  
Fernando de Mendonça Cardoso ◽  
Edson Marchiori
Keyword(s):  
Case Report ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Neurological Disorders ◽  
Preliminary Report ◽  
Clinical Laboratory ◽  
The Novel ◽  
Posterior Reversible Encephalopathy ◽  
Current Health ◽  
Reversible Encephalopathy ◽  
A Current

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an epidemic in December 2019 in Wuhan, China, which became a pandemic (as designated by the WHO), creating a current health emergency.1 A preliminary report warned that SARS-CoV-2 had neuroinvasive potential, as some infected patients had neurological symptoms such as headache, nausea, and vomiting.2 Several subsequent reports have described the emergence of various neurological disorders in the evolution of SARSCoV-2 infectious processes. In this article, we report the case of a patient with COVID-19 who presented with posterior reversible encephalopathy syndrome (PRES), diagnosed on clinical, laboratory, and imaging bases.

scholarly journals Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders

2020 ◽  
Vol Volume 16 ◽  
pp. 977-984
Author(s):  
Lei Bao ◽  
Qing Li ◽  
Qingjie Li ◽  
Hao Chen ◽  
Ruixue Zhang ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Disorders ◽  
Radiological Features

scholarly journals Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations

2021 ◽  
Vol 12 ◽  
Author(s):  
Juanjuan Zhang ◽  
Dandan Xie ◽  
Yanfeng Zou ◽  
Xuen Yu ◽  
Yang Ji ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Peripheral Neuropathy ◽  
Subgroup Analysis ◽  
Neurological Disorders ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Neurological Dysfunction ◽  
Asian Patients ◽  
Initial Symptoms

Background: Nitrous oxide (N2O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N2O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, especially in China. Here, we have summarized the key clinical characteristics of N2O-induced neurological disorders.Materials and Methods: We recruited 20 patients with N2O-induced neurological disorders and analyzed their clinical features, laboratory data, magnetic resonance imaging and electromyography. We also carried out a literature review and compared 99 previously reported patients with our case series to confirm our results. Subgroup analysis was performed to explore the difference in demographical and clinical characteristics of N2O abuse between Asian and non-Asian patients.Results: The most common initial symptoms of N2O-induced neurological disorders were weakness and/or paresthesia. Most patients presented with myelopathy and/or peripheral neuropathy. The most commonly involved segment of the spinal cord was the cervical spinal cord, extending over 4–6 vertebral levels, but more than half of the patients with myelopathy had no sensory change at the corresponding spinal level. Homocysteine was found to be the most sensitive and practical indicator for diagnosis. Subgroup analysis showed that the Asian patients (median: 22.0 years old, Q1–Q3:19.0–26.0 years old) with N2O abuse were younger than non-Asian patients [26.0 (22.3–31.0) years old, P = 2.8 × 10−4]. The incidence of myelopathy combined with peripheral neuropathy was significantly higher in Asian patients than in non-Asian patients, who had myelopathy or peripheral neuropathy (P = 2 × 10−5).Conclusions: Key clinical characteristics of N2O abuse are longitudinally extensive cervical myelopathy and peripheral neuropathy. Recognition of these traits in young people in the age group of 20–30 years will provide important guidance for accurate diagnosis of neurological disease associated with N2O abuse. The clinical manifestations differ in Asian patients and non-Asian patients.

scholarly journals Nitrous Oxide-Induced Neuropathy among Recreational Users in Vietnam

2021 ◽  
Vol 18 (12) ◽  
pp. 6230
Author(s):  
Xuan Thi Dang ◽  
Thanh Xuan Nguyen ◽  
Thu Thi Hoai Nguyen ◽  
Hung Tran Ha
Keyword(s):  
Nitrous Oxide ◽  
Neurological Disorders ◽  
Clinical Symptoms ◽  
Demographic Characteristics ◽  
Poison Control ◽  
Poison Control Center ◽  
Sectional Study ◽  
Control Center ◽  
Laughing Gas ◽  
The Mean

Nitrous oxide (N2O) commonly referred to as laughing gas, has significant medical uses. This study aims to describe the neurological disorders associated with N2O. We conducted across-sectional study that enrolled patients with nitrous oxide toxicity admitted to Vietnam Poison Control Center, Bach Mai Hospital, Hanoi, Vietnam from June 2018 to July 2019. The questionnaire included demographic characteristics, characteristics of using N2O, signs and clinical symptoms, neuroimaging findings, injury on electromyography (EMG) and the Total Neuropathy Score clinical version (TNSc) criteria. A total of 47 participants were included with mean age: 24.38 ± 6.20 years. The number of balloons used per week was 130.59 ± 117.43. The mean duration of N2O exposure was 8.79 ± 7.1 months. Multivariate linear logistic regression revealed that the number of N2O balloons used per week was significantly associated with TNSc point (Beta: 0.315; 95% CI: 0.001–0.022). We found that myeloneuropathy and peripheral neuropathy were the main neurological disorders related to N2O abuse, which should improve the awareness of the appearance of neurological disorders associated with N2O abuse.

scholarly journals Global Burden Related to Nitrous Oxide Exposure in Medical and Recreational Settings: A Systematic Review and Individual Patient Data Meta-Analysis

2019 ◽  
Vol 8 (4) ◽  
pp. 551 ◽  
Author(s):  
Abderrahim Oussalah ◽  
Mélissa Julien ◽  
Julien Levy ◽  
Olivia Hajjar ◽  
Claire Franczak ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Individual Patient Data ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Vitamin B12 Deficiency ◽  
Patient Data ◽  
B12 Deficiency

The risk of adverse effects of nitrous oxide (N2O) exposure is insufficiently recognized despite its widespread use. These effects are mainly reported through case reports. We conducted an individual patient data meta-analysis to assess the prevalence of clinical, laboratory, and magnetic resonance findings in association with N2O exposure in medical and recreational settings. We calculated the pooled estimates for the studied outcomes and assessed the potential bias related to population stratification using principal component analysis. Eighty-five publications met the inclusion criteria and reported on 100 patients with a median age of 27 years and 57% of recreational users. The most frequent outcomes were subacute combined degeneration (28%), myelopathy (26%), and generalized demyelinating polyneuropathy (23%). A T2 signal hyperintensity in the spinal cord was reported in 68% (57.2–78.8%) of patients. The most frequent clinical manifestations included paresthesia (80%; 72.0–88.0%), unsteady gait (58%; 48.2–67.8%), and weakness (43%; 33.1–52.9%). At least one hematological abnormality was retrieved in 71.7% (59.9–83.4%) of patients. Most patients had vitamin B12 deficiency: vitamin B12 <150 pmol/L (70.7%; 60.7–80.8%), homocysteine >15 µmol/L (90.3%; 79.3–100%), and methylmalonic acid >0.4 µmol/L (93.8%; 80.4–100%). Consistently, 85% of patients exhibited a possibly or probably deficient vitamin B12 status according to the cB12 scoring system. N2O can produce severe outcomes, with neurological or hematological disorders in almost all published cases. More than half of them are reported in the setting of recreational use. The N2O-related burden is dominated by vitamin B12 deficiency. This highlights the need to evaluate whether correcting B12 deficiency would prevent N2O-related toxicity, particularly in countries with a high prevalence of B12 deficiency.

scholarly journals Prediction of Neurological Outcomes in Patients with Post-Cardiac Arrest Syndrome

2021 ◽  
Vol 18 (3) ◽  
pp. 72-78
Author(s):  
T. G. Markova ◽  
N. V. Bragina ◽  
V. I. Gorbachev
Keyword(s):  
Cardiac Arrest ◽  
Neurological Disorders ◽  
Neurological Outcome ◽  
Clinical Laboratory ◽  
Neuron Specific Enolase ◽  
High Sensitivity ◽  
Neurological Outcomes ◽  
Results Of Treatment ◽  
Pupillary Responses ◽  
Post Cardiac Arrest Syndrome

Post-cardiac arrest syndrome is an extremely complex nosology, characterized by high mortality and the development of severe neurological disorders. Predicting the neurological outcome in this pathology is an urgent problem, since it allows determining the tactics of patient management and optimizing the scope of medical care, as well as preparing the patient's family members for expected results of treatment. Currently, clinical, laboratory and instrumental data are used as predictors of an unfavorable neurological outcome (e.g., pupillary responses, neuron-specific enolase levels, electroencephalography). There is no single criterion with high sensitivity and specificity for predicting neurological disorders; therefore, a multimodal approach is required. This article discusses several factors, the combination of which allows predicting the outcome of post-cardiac arrest syndrome with the greatest degree of reliability.

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