{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:00:17Z","timestamp":1790190017784,"version":"4.1.0"},"reference-count":5,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,5,12]]},"abstract":"<jats:p>\n                    A 36-year-old man presented to hospital with a 5-week history of ascending limb paraesthesiae and balance difficulties. He had no medical or travel history of note, but admitted habitual nitrous oxide (N\n                    <jats:sub>2<\/jats:sub>\n                    O) inhalation. Neurological examination revealed a sensory ataxia with pseudoathetosis in the upper limbs and reduced vibration sensation to the hips bilaterally. Significant investigation results included a low serum vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    concentration, mild macrocytosis and raised serum homocysteine concentration. T2 MRI of the spinal cord demonstrated increased signal extending from C1 to T11 in keeping with a longitudinal myelitis. The patient was diagnosed with a myeloneuropathy secondary to vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    deficiency, resulting from heavy N\n                    <jats:sub>2<\/jats:sub>\n                    O inhalation. He was treated with intramuscular vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    injections and received regular physiotherapy. At discharge, he was able to mobilise short distances with the aid of a zimmer frame, and was independently mobile 8\u2005weeks later.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2016-215728","type":"journal-article","created":{"date-parts":[[2016,5,31]],"date-time":"2016-05-31T08:53:07Z","timestamp":1464684787000},"page":"bcr2016215728","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Nitrous oxide misuse and vitamin B\n                    <sub>12<\/sub>\n                    deficiency"],"prefix":"10.1136","volume":"2016","author":[{"given":"Thomas H","family":"Massey","sequence":"first","affiliation":[{"name":"Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor T","family":"Pickersgill","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cardiff and Vale University Health Board, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"J Peall","sequence":"additional","affiliation":[{"name":"Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,5,31]]},"reference":[{"key":"2025082701073868000_2016.may31_1.bcr2016215728.1","first-page":"43","article-title":"Myeloneuropathy from nitrous oxide abuse: unusually high methylmalonic acid and homocysteine levels","volume":"102","author":"Waclawik","year":"2003","journal-title":"WMJ"},{"key":"2025082701073868000_2016.may31_1.bcr2016215728.2","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"2025082701073868000_2016.may31_1.bcr2016215728.3","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20840"},{"key":"2025082701073868000_2016.may31_1.bcr2016215728.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2006.00525.x"},{"key":"2025082701073868000_2016.may31_1.bcr2016215728.5","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000133406.50055.41"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-215728","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:07:47Z","timestamp":1756282067000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-215728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,31]]},"references-count":5,"alternative-id":["10.1136\/bcr-2016-215728"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-215728","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,31]]}}}