200 Section - Recreational Nitrous Oxide use leading to Subacute Combined Degeneration of the Spinal Cord in Four East Asian Patients Presenting to Neurorehabilitation: a Case Series

Subacute combined degeneration of the spinal cord secondary to chronic nitrous oxide use.

Case Description:

The use of nitrous oxide (N₂O), also known as “laughing gas”, as a recreational drug has become popular among young adults in Canada. It is readily available and legal to obtain in the form of small canisters or “whippets”. Nitrous oxide can have neurotoxic effects that may present clinically as paresthesia, weakness, gait disturbances, and altered cognition. We report a series of 4 patients who presented to an acute inpatient physiatry service between 2022 and 2024 with myelopathy secondary to chronic nitrous oxide use. All patients were aged 20 to 30 years and were of East Asian ethnicity. Seventy-five percent were female, had no history of other substance use disorders, and achieved a university level of education. Functional outcomes post rehabilitation treatment varied from near full functional recovery to chronic wheelchair or brace use for mobility.

Discussions:

To date, there has not been a study conducted on the associations between socio-economic traits and nitrous oxide use in the Canadian context.  International studies suggest disproportionate representation of Asian or non-Western ethnicities. This case series presents the first description of a cluster of East Asian young adults in a Canadian neurorehabilitation setting. The findings suggest that early recognition, culturally informed patient education, and targeted prevention strategies are important. They also identify questions for future research, including how cultural background and stigma may influence risk perception, help-seeking behaviour, and rehabilitation engagement.

Conclusions:

In young adult patients presenting with non-traumatic gait disturbance, neuropathy, and vitamin B12 deficiency, clinicians should maintain a high suspicion for nitrous oxide use as a possible etiology. Early diagnosis and treatment are critical to optimizing neurological and functional recovery.