The recreational use of nitrous oxide (N
2
O) is a growing public health concern. Increasing numbers of young individuals are presenting to accident emergency departments complaining of adverse neurological symptoms as a result of N
2
O induced vitamin B12 deficiency. Despite its increasing popularity, many are still not aware of its devastating potential to cause a myriad of severe longstanding neurological impairment. Herein we present a case that highlights the effects of N
2
O abuse and the best way to investigate and manage such patients.
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