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亜酸化窒素吸入による亜急性複合変性。2つの症例報告
Subacute combined degeneration induced by nitrous oxide inhalation: Two case reports.
PMID: 32358361 DOI: 10.1097/MD.0000000000019926.
抄録
理論的根拠:
笑気ガスとして知られる亜酸化窒素（N2O）は，若年層を中心にレクリエーション薬物として乱用されており，後に脊髄症や末梢神経障害を引き起こすことがあるが，中国ではN2Oの乱用による神経学的悪化例はほとんど報告されていない．
RATIONALE: Nitrous oxide (N2O), commonly known as "laughing gas," is being increasingly abused by young people as a recreational drug; this can subsequently result in myelopathy and peripheral neuropathy, however, in China, few cases of neurologic deterioration by N2O abuse have been reported.
患者の悩み:
ここでは、進行性の四肢脱力、しびれ、運動失調を呈した2名の患者を紹介する。両者とも長期間にわたりレクリエーションでN2Oを断続的に吸入していた。
PATIENT CONCERNS: Herein, we present 2 patients who developed progressive limb weakness, numbness, and ataxia. Both of them had recreationally inhaled N2O intermittently for a long time.
ダイアグノシス:
N2O乱用後のミオパチーと多神経症に基づく亜急性複合変性（SCD）。
DIAGNOSIS: Subacute combined degeneration (SCD) based on myelopathy and polyneuropathy after N2O abuse.
インターベンション:
2名の患者には、N2O吸入の中止、メチルコバラミンカプセル500μg tid (ter in die, つまり1日3回)、および化合物ビタミンB 1錠 tid p.o. (per os, つまり経口摂取)を1ヶ月間投与した。
INTERVENTIONS: The 2 patients were treated with cessation of N2O inhalation, methylcobalamin capsule 500 μg tid (ter in die, which means 3 times a day), and compound vitamin B 1 tablet tid p.o.(per os, which means taken orally) for 1 month.
アウトカム:
感覚が変わる症状と患者さんの歩行が大幅に改善しました。
OUTCOMES: The symptoms of altered sensation and the patients' gait improved significantly.
レッスンの内容:
この2例は，N2Oの神経毒性の重要なメカニズムについての認識を高めるものであり，臨床医はこのような物質関連疾患について十分に認識しておく必要がある．N2Oによる神経毒性の発生率は十分に認識されておらず，特に未分化な脱力感や感覚異常を呈する青年期のSCDの重要な原因と考えるべきである．
LESSONS: The 2 cases raise awareness of the important mechanisms of N2O neurotoxicity, and clinicians should be made fully aware of such substance-related diseases. The incidence of N2O -induced neurotoxicity is insufficiently recognized and should be considered as an important cause of SCD, especially in adolescents with undifferentiated weakness and abnormal sensation; this is essential because serious complications such as irreversible paralysis can result from the absence of early diagnosis and treatment.