Abstract Details

Title No Laughing Matter: A Case of Nitrous Oxide Toxicity and Factitious Disorder

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 078

Objective To report a case of nitrous oxide toxicity in a patient with factitious disorder.

Background Nitrous oxide (N₂O), used as an anesthetic and recreationally, has serious medical sequelae affecting the CNS that can lead to myelopathy and neuropathy. The risk of adverse effects of N₂O exposure remains insufficiently recognized despite its common use.

Design/Methods N/A

Results A 46 year old man with a history of factitious disorder presented with complaints of shaking legs for the past 15 years. He had a history of lumbar radiculopathy and discectomy 14 years prior. He initially complained of progressive shakiness in the legs, sensory changes in the feet, urinary incontinence, and erectile dysfunction. Examination revealed bilateral foot drop, hyperreflexia in the lower extremities, and spastic gait changes without significant objective sensory changes. EMG/NCS revealed a mixed axonal and demyelinating distal motor polyneuropathy. Labs and imaging were unremarkable. After several visits, the patient revised his history, revealing that for at least a year prior to the onset of these symptoms he had been using nitrous oxide recreationally every day. He also explained that his symptoms had in-fact stabilized after he stopped using N₂O.

Conclusions N₂O toxicity is easily missed given the frequent comorbidity with other substance use disorders and difficulty of detection without a high index of suspicion. This case highlights the importance of frequent diagnostic re-evaluation as additional history becomes available with an evolving doctor-patient relationship. Patients with factitious disorder, though unconscious of secondary gain (attention, disability funds), must be conscious of the exact nature of damage being done to self, and it is unlikely that this patient was aware of this rare complication of N₂O toxicity. This was a case in which factitious disorder did not directly contribute to the neurological damage, but rather made it difficult to diagnose the true underlying etiology.

Authors/Disclosures
Han S. Lee PRESENTER	Mr. Lee has nothing to disclose.
Jason Massa, DO, FAAN (East Bay Neurology)	Dr. Massa has nothing to disclose.

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