Nitrous oxide, also known as “laughing gas,” is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.

Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that occurs in approximately one in 1000 live births. Patients may be asymptomatic or present with symptoms such as hypertension, hematuria, proteinuria, or renal function impairment. It can present with extra renal complications like cerebral aneurysms, hepatic and pancreatic cysts, infected cysts, cardiac valve disease, colonic diverticula, abdominal wall and inguinal hernia, and seminal vesicle cyst. Imaging studies such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) provide vital information regarding the diagnosis of the disease, monitoring of the progression of the disease, and detection of complications from the disease. We present the case of a 40-year-old male who developed extra-renal complications, and how different imaging modalities facilitated and enabled us to optimize the care of this patient in a timely manner.