Neuropsychiatric sequelae of chronic nitrous oxide misuse in middle‐aged adults: A case series
Theodore Tsonis, Nassima Ait‐Daoud Tiouririne, Nathan P. Charlton, Avery MichienziAbstract
Background and Objectives
Chronic nitrous oxide (N 2 O) misuse causes heterogeneous neuropsychiatric toxicity.
Methods
We retrospectively reviewed three middle‐aged adults with chronic N 2 O misuse and neuropsychiatric presentations.
Results
Presentations included cognitive impairment, hallucinations, and variable neurologic dysfunction. Homocysteine was markedly elevated in all patients, while vitamin B12, methylmalonic acid, hematologic indices, and longitudinal outcomes varied.
Discussion and Conclusions
These cases illustrate heterogeneous biochemical and clinical trajectories, with biochemical abnormalities not consistently corresponding to clinical severity or recovery.
Scientific Significance
Clinicians should specifically assess N 2 O exposure in unexplained neuropsychiatric presentations and interpret cobalamin‐related biomarkers in clinical context.