Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report
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CASE REPORT
Open Access
Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report Mao Liu1, Jing Zhang2 and Bitao Bu1*
Abstract Background: Nitrous oxide has become a popular inhalant as abused substance by young Chinese people in recent years. It has been mainly associated with medical conditions including megaloblastic anemia and myeloneuropathy. Case presentation: We report a case of a 25-year-old high school graduate who had been abusing nitrous oxide for twenty months. She had a history of peripheral neuropathy and subacute combined degeneration in between. The young woman presented with headache, motor aphasia and right arm paralysis of eight hours after intermittently consuming nitrous oxide for one week. D-dimer was increased (1.1 mg/ml). Blood vitamin B12, folate, homocysteine and beta-HCG levels were normal. Head CT showed hemorrhagic infarction and subarachnoid hemorrhage. MR angiography and venography were normal. Head MRI identified left frontal isolated cortical vein thrombosis. Her muscle strength and verbal fluency significantly improved after initiation of Low Molecular Weight Heparin and serial head MRI showed continuous reduction in the size of thrombus. Conclusions: For the first time nitrous oxide use is found to be related to isolated cortical vein thrombosis. Public education regarding the potential consequences of abusing nitrous oxide especially in high-risk individuals is urgently needed. Keywords: Nitrous oxide, Subacute combined degeneration, Peripheral neuropathy, Isolated cortical vein thrombosis, Case report
Background Nitrous oxide has been widely used as an anesthetic agent in the medical field. However, previous studies have found its use is associated with various medical conditions including macrocytic anemia, peripheral neuropathy, subacute combined degeneration, deep vein thrombosis, pulmonary embolism, aortic thrombosis and cerebral venous sinus thrombosis [1–20]. Here for the first time we report a young woman with isolated cortical vein thrombosis related to nitrous oxide use.
* Correspondence: [email protected] 1 Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China Full list of author information is available at the end of the article
Case presentation Medical history
A 25-year-old Chinese woman presented with headache and difficulty in speaking and moving the right arm for the last eight hours. She used oral contraceptives once ten days ago and inhaled nitrous oxide outside with friends in the last week. The patient began to use oxide intermittently twenty months ago. She gradually developed numbness and weakness of distal limbs, and balance difficulty, which significantly improved after vitamin B12 intake of one month. One year ago her numbness in the distal limbs subacutely deteriorated and ascended to both proximal thighs and the upper trunk. Medical record showed she had impaired superficial sensation of both hands, feet and the thorax region from
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