Ann Rehabil Med.  2019 Aug;43(4):530-534. 10.5535/arm.2019.43.4.530.

Subacute Combined Degeneration Caused by Nitrous Oxide Intoxication: A Report of Two Cases

  • 1Department of Rehabilitation Medicine, Gil Medical Center, Incheon, Korea.
  • 2Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.


We report two cases of subacute combined degeneration (SCD) caused by nitrous oxide (N₂O) gas intoxication, which is rarely reported in Korea. Two patients recreationally inhaled N₂O gas daily for several months. They presented with paresthesia of limbs, voiding difficulty, and gait disturbance. The initial vitamin B₁₂ levels were normal or decreased, but homocysteine levels of the two patients were increased. Magnetic resonance imaging of the cervical spine showed T2-weighted hyperintensity in the bilateral dorsal columns of the cervical spinal cord. Electromyography and somatosensory evoked potential tests for both patients suggested posterior column lesion of the spinal cord combined with sensorimotor polyneuropathy. According to these findings, we concluded that the two patients had SCD. The patient's symptoms partially improved after cessation of N₂O gas inhalation and the receiving of vitamin B₁₂ supplementation therapy. As the incidence of recreational N₂O gas inhalation is increasing in Korea, physicians must be alert to the N₂O induced SCD in patients presenting with progressive myelopathy.


Nitrous oxide; Subacute combined degeneration; Vitamin B12
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