{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:51:33Z","timestamp":1785588693795,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T00:00:00Z","timestamp":1652140800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Neurological presentations resulting from nitrous oxide (N<jats:sub>2<\/jats:sub>O) abuse are increasing in Australia and worldwide. Despite known neuropsychiatric sequelae, N<jats:sub>2<\/jats:sub>O canisters remain readily available and its use unregulated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To examine the demographics, clinical and electrophysiological findings of patients presenting with neurological complications of N<jats:sub>2<\/jats:sub>O abuse, and thus inform clinicians and public health decision\u2010makers of the significant public health concerns of this increasing practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients presenting to a tertiary referral metropolitan hospital were included in this series. Patients were identified by a search of discharge summaries of patients admitted with acute or subacute neuropathy or myelopathy and a history of N<jats:sub>2<\/jats:sub>O abuse, and from the electrophysiology database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen patients were identified, most presenting with subacute paraesthesia, sensory ataxia and lower limb weakness. Eleven had low serum vitamin B<jats:sub>12<\/jats:sub>. Spinal magnetic resonance imaging was consistent with subacute combined degeneration in eight. Nerve conduction studies revealed a motor or sensorimotor axonal neuropathy (three with motor predominance). There was a bimodal demographic distribution consisting of socially isolated, international university students and local residents with a history of mental illness and polydrug abuse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Recreational N<jats:sub>2<\/jats:sub>O use is an emerging health problem in Australia. International university students and patients with pre\u2010existing mental illness or polydrug use appear to be at increased risk. A severe motor neuropathy may emerge following vitamin B<jats:sub>12<\/jats:sub> replacement. Public health measures are required to limit the availability of N<jats:sub>2<\/jats:sub>O and to educate adolescents and young adults about the potential for significant harm.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15544","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T19:28:27Z","timestamp":1632770907000},"page":"740-744","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Nitrous <scp>oxide\u2010induced<\/scp> neurological disorders: an increasing public health concern"],"prefix":"10.1111","volume":"52","author":[{"given":"Jessica","family":"Redmond","sequence":"first","affiliation":[{"name":"Department of Neurology Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8383-1667","authenticated-orcid":false,"given":"Belinda","family":"Cruse","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynette","family":"Kiers","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjaceaccp\/mki039"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8801-3"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2007.tb01283.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2015.10.017"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev297"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116632375"},{"key":"e_1_2_6_9_1","volume-title":"Global Drug Survey (GDS) 2020. Key Findings Report","author":"Winstock A","year":"2020"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50371"},{"key":"e_1_2_6_11_1","volume-title":"Australian Drug Trends 2019: Key Findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews","author":"Peacock A","year":"2019"},{"key":"e_1_2_6_12_1","volume-title":"When Nitrous Oxide Use Is No Laughing Matter","author":"Greene S","year":"2020"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50377"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.5582\/irdr.2020.01007"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8040551"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09600-w"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S236939"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12640-021-00352-y"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12372"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24482"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu5114521"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119882532"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(78)92101-3"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317768"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00704"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2016.08.005"},{"key":"e_1_2_6_27_1","unstructured":"Government of South Australia. Attorney\u2010General's DepartmentNitrous Oxide Regulations. [cited 2021 Sep 4]. Available from URL:https:\/\/www.agd.sa.gov.au\/justice-system\/nitrous-oxide-regulations"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15544","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.15544","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T12:07:39Z","timestamp":1692878859000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.15544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1111\/imj.15544"],"URL":"https:\/\/doi.org\/10.1111\/imj.15544","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]},"assertion":[{"value":"2021-07-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}