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Case Reports
. 2020 Oct 20;20(1):378.
doi: 10.1186/s12883-020-01961-4.

Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report

Mao Liu  1 , Jing Zhang  2 , Bitao Bu  3
Affiliations
Case Reports

Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report

Mao Liu et al. BMC Neurol. .

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: Case report; Isolated cortical vein thrombosis; Nitrous oxide; Peripheral neuropathy; Subacute combined degeneration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Head CT upon admission showed hemorrhagic infarction mainly involving the left parietal lobe (a-c, arrow) and subarachnoid hemorrhage (c, arrow heads)
Fig. 2
Fig. 2
Head MRI ten days after admission showed isolated cortical vein thrombosis (arrow head) over the frontal cortical surface and expanding hematoma and edema (double arrow head) that caused cingulate herniation in the sagittal, coronal and axial section (a-c) on T2 SPACE sequence. The sizes of thrombosis (arrow head), hematoma and edema (double arrow head) continuously decreased on T1 CUBE sequence after five (d-f) and twelve (g-i) days of anticoagulation, respectively
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