Nitrous oxide (N2O), an anesthetic gas, has been abused by some people for entertainment purposes. Recently, N2O (under the name of "Happy Balloon") abuse has become problematic among young people in Korea. N2O intoxication can develop a neuropathy, as well as other systemic disorders, either by inactivating vitamin B12 or by a direct neurotoxic mechanism. Here, we report a case of peripheral neuropathy with possible coexisting myelopathy following N2O abuse.
In Guillain-Barré syndrome (GBS) and its variant, anti-GQ1b antibody has a pathogenic role for ophthalmoplegia. In addition, anti-GT1a antibody is related with lower cranial nerve involvement. This report describes a 60-year-old male patient with GBS manifesting with initially isolated dysphagia and subsequently developed ophthalmoplegia. Both immunoglobulin G type anti-GQ1b and anti-GT1a antibodies were detected in the patient’s serum. A mechanism regarding subsequent involvement of respective cranial nerves remains to be elucidated.
Background Pulsatility of cerebral arteries and aortic stiffness have been associated with
white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct.
Methods We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis.
Results Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719.
Conclusions PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.
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Distinct association between cerebral arterial pulsatility and subtypes of cerebral small vessel disease Ki-Woong Nam, Hyung-Min Kwon, Yong-Seok Lee, Masaki Mogi PLOS ONE.2020; 15(7): e0236049. CrossRef
Characterizing pulsatility in distal cerebral arteries using 4D flow MRI Tomas Vikner, Lars Nyberg, Madelene Holmgren, Jan Malm, Anders Eklund, Anders Wåhlin Journal of Cerebral Blood Flow & Metabolism.2020; 40(12): 2429. CrossRef
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