Abstracts

Rationale: Duster inhalant abuse (Difluoroethane) and its effects have been described. We report a case of recurrent spells associated with duster inhalation abuse.Methods: We report a patient with recurrent spells associated with duster inhalation, mimicking a seizure disorder. Results: A 24 year-old man with history of major depression and ulcerative colitis was admitted to Hines VA hospital after a fall. He fell down the stairs and hit his head against the floor with possible loss of consciousness. Later that day he was found on the floor with shaking of his head and both upper extremities during which he was not responding to external stimuli. This episode lasted for about a minute. There was no associated bowel or bladder incontinence. On evaluation in the hospital, his neurological examination was unremarkable. Upon admission, his routine laboratory studies, Urine drug screen, CT head, MRI brain with gadolinium and EEG were unremarkable. He was discharged home with the plan to follow-up as an Out-patient. The patient was readmitted within 24 hrs after discharge due to similar episodes. Some of these episodes were milder and others severe. During his second admission, he also developed intense headaches associated with dizziness, nausea and photophobia before the episodes. Cerebrospinal fluid analysis was negative for infection. His EKG and telemetry monitoring were unremarkable. Video EEG recorded four events of head shaking, body jerk and confusion during which no electrographic ictal rhythms were noted. He was discharged with the diagnosis of Non-epileptic seizure disorder. He was again readmitted 3 days later with similar episodes. The episodes at that time were more intense with associated unresponsiveness to external stimuli, falls and bruises on his body from injuries sustained during the episodes. During this admission, patient was found inhaling computer duster spray prior to one of the episodes. He later acknowledged sniffing duster prior to his episodes. He also stated that he had started inhaling duster more often to decrease his mental pain and stress. Conclusions: Duster inhalation abuse can cause recurrent spells, mimicking a seizure disorder. It should be considered in the differential diagnosis of recurrent spells. Providers need to be aware of duster inhalation abuse and its clinical manifestations. Commercially available computer duster spray contains Difluroethane. This volatile inhalant can cause CNS depression, lethargy or euphoria, loss of muscular tone and in-coordination. We believe recurrent spells are another manifestation of difluroethane inhalation. Non neurological effects of inhalation of this substance have been described including fatal cardiac arrhythmias and sudden deaths.