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Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment
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  • Alexis Demas
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    I read the article by Alvar Paris et al. with great interest. The consumption of nitrous oxide (N2O) has recently surfaced as an exponentially growing form of recreational abuse, particularly among students, due to its euphoric effects and accessibility. The European Monitoring Centre for Drugs and Drug Addiction has expressed concern in a recent report about the recreational use of N2O in Europe. 1
    The most common neurological complications associated with N2O consumption are toxic polyneuropathy and subacute combined degeneration of the spinal cord (N2O-SACD), which may occur concurrently— a critical aspect that should not be overlooked. Initial clinical descriptions of N2O-SACD were reported in 2015 and complicated episodic use mediated through canisters. 2 Recently, the market for N2O distribution has expanded with diverse consumption accessories. The introduction of larger cylinders facilitates the consumption of significant amounts of N2O, posing younger individuals at an elevated risk of early and severe Vitamin B12 deficiency along with systemic complications. Consequently, new complications associated with N2O intoxication have been described, and their wide-ranging effects are regularly emphasized in the literature.
    Beyond psychiatric symptoms like hallucinations, cognitive impairments including Gayet-Wernicke's encephalopathy have been recently reported. 3 These deficiencies are mediated by Vitamin B1 levels, suggesting a risk of broader deficie...

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    None declared.

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