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NEUROLOGY 1986;36:1618
© 1986 American Academy of Neurology

Nitrous oxide

Clinical and electrophysiologic investigation of neurologic complications Eric J. Heyer, David M. Simpson, Ivan Bodis-Wollner and Sidney P. Diamond

Department of Neurology, The Mount Sinai School of Medicine, New York, NY.

Prolonged exposure to nitrous oxide produces a recognized neurologic syndrome. We report clinical and electrophysiologic studies of nervous system involvement in a 25-year-old student who abused nitrous oxide. He developed signs of a sensorimotor polyneuropathy and of myelopathy. Routine blood studies, CSF examination, and myelogram were normal. Clinical electrophysiologic studies were performed serially. Nerve conduction studies demonstrated reduced amplitude and slowed sensory potentials, and mildly prolonged late responses. Sensory evoked potentials revealed prolonged latency of scalpevoked potentials from tibial nerve stimulation with normal median nerve values. The foveal visual evoked potential was delayed in the right eye, with normal visual acuity, funduscopic examination, and spatial contrast sensitivity. Repeat electrophysiologic studies demonstrated improvement. Nitrous oxide produces multifocal reversible dysfunction within the nervous system similar to that described in patients with vitamin B12 deficiency.

Address correspondence and reprint requests to Dr. Heyer, Department of Neurology, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029.

E.J.H. was supported in part by NINCDS Teacher-Investigator Award (NS 00657). I.B-W. was supported in part by National Eye Institute (NEI) grant no. EY 01708; Core Center grant no. EY 01867, NEI; Clinical Center for Research in Parkinson's and Allied Disease, no. NS-11631; and NIH grant no. RR-00071, Division of Research Resources, General Research Center Branch.

Accepted for publication March 26,1986.