Neurological and cardiac symptomatology in a teenager in the context of chronic nitrous oxide use: A case report.

Chronic use of nitrous oxide can lead to motor complications. We report the case of a 15-year-old boy with rapid onset of lower limb paralysis after massive nitrous oxide intake. He had been previously hospitalized for the same symptoms, but did not mention the use of nitrous oxide and no etiology was found. During hospitalization, he presented with two consecutive self-limited episodes of ventricular tachycardia. Currently, no routine tests are performed to confirm nitrous oxide toxicity. This case highlights the recurrent nature of the motor deficits and suggests a possible association between motor deficits and cardiac rhythm disorders in the setting of nitrous oxide intoxication.

Focus on cannabinoids and synthetic cannabinoids.

The recent emergence of a multitude of synthetic cannabinoids (SCs) has generated a wealth of new information, suggesting the usefulness of state-of-the-art on lato sensu cannabinoids. By modulating a plurality of neurotransmission pathways, the endocannabinoid system is involved in many physiological processes that are increasingly explored. SCs desired and adverse effects are considered to be more intense than those observed with cannabis smoking, which is partly explained by the full agonist activity and higher affinity for cannabinoid receptors. Neurological and cardiovascular side effects observed after cannabinoid poisoning generally respond to conventional supportive care, but severe outcomes may occur in a minority of cases, mainly observed with SCs. The likelihood of severe abuse and addiction produced by SCs are of concern for the scientific community also interested in the potential therapeutic value of cannabinoids.

[Trimetazidine-induced encephalopathy with choreiform disorders: a case report]. / Encéphalopathie avec mouvements choréiformes induits par la trimétazidine: à propos d'un cas.

Trimetazidine is known to induce parkinsonism but choreiform disorders have not yet been described with this drug. A 88-year-old patient treated with trimetazidine developed choreiform movements, gait disorders, tremor and visual hallucinations. These symptoms disappeared after drug withdrawal. Although this drug contains a piperazinic ring like other anti-dopaminergic drugs which are already known to potentially induce chorea like neuroleptics and some anti-convulsive drugs. When a patient treated with trimetazidine develops or worsens motor disorders (parkinsonism or choreiform disorders), this drug must be stopped.

[Should we care about pregabalin for elderly patients with a history of cardiac dysrhythmia?]. / Faut-il se méfier de la prégabaline chez les patients âgés aux antécédents de troubles du rythme cardiaque ?

Pregabalin is similar in structure to gamma-aminobutyric acid. It is used for neuropathic pain, generalized anxiety disorders and as an adjunct therapy for partial seizures. Tachycardia is a rare side-effect. A 92-year-old patient with a history of paroxystic fibrillation was hospitalised for zoster. She developed a sinusal tachycardia followed by atrial fibrillation and congestive heart failure 15 h after a first dose of pregabalin. The imputation was considered as plausible. Even though the mechanism remains unclear, pregabalin might induce tachycardia in predisposed old patients.