Myeloneuropathy after prolonged exposure to nitrous oxide

Lancet. 1978 Dec 9;2(8102):1227-30. doi: 10.1016/s0140-6736(78)92101-3.


A neurological disorder developed after prolonged exposure to nitrous oxide in 15 patients, all but 1 of whom were dentists. 13 patients had abused nitrous oxide to some extent for periods ranging from 3 months to several years, but 2 patients were exposed to nitrous oxide only professionally, by working in poorly ventilated surgeries. Symptoms included early sensory complaints, Lhermitte sign, loss of balance, leg weakness, gait ataxia, impotence, and sphincter disturbances. Neurological examination showed sensorimotor polyneuropathy, often combined with signs of involvement of the posterior and lateral columns of the spinal cord. Electrodiagnostic tests pointed to an axonal polyneuropathy, but other laboratory results were normal, including examination of the spinal fluid. The neurological picture is similar to that of subacute combined degeneration of the spinal cord, and it is possible that nitrous oxide interferes with the action of vitamin B12 in the nervous system.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthesia, Dental / adverse effects*
  • Arm / innervation
  • Dental Technicians*
  • Dentists*
  • Erectile Dysfunction / chemically induced
  • Humans
  • Leg / innervation
  • Male
  • Middle Aged
  • Muscles / innervation
  • Nervous System Diseases / chemically induced*
  • Nitrous Oxide / adverse effects*
  • Occupational Diseases / chemically induced*
  • Paresthesia / chemically induced
  • Peripheral Nervous System Diseases / chemically induced
  • Sensation
  • Spinal Cord Diseases / chemically induced
  • Substance-Related Disorders*
  • Time Factors


  • Nitrous Oxide