{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:30:06Z","timestamp":1766428206696,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,9,21]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>A 27-year-old woman presented with confusion, agitation and fever. Having initially been treated as an infective encephalitis case her initial and subsequent lumbar punctures revealed cerebrospinal fluid with a worsening pleocytosis and elevated protein. It was initially felt she had been suffering from tuberculous meningitis and started on treatment it later became apparent that she had a severe vitamin B<jats:sub>12<\/jats:sub> deficiency related to recreational nitrous oxide use. She also was noted to have a peripheral neuropathy. After replacing her vitamin B<jats:sub>12<\/jats:sub> and later stopping her tuberculous medication once cultures were negative her cognition and peripheral neuropathy continued to improve.<\/jats:p>","DOI":"10.1136\/bcr-2019-229380","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T05:35:47Z","timestamp":1575351347000},"page":"e229380","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Encephalitis secondary to nitrous oxide and vitamin B<sub>12<\/sub> deficiency"],"prefix":"10.1136","volume":"12","author":[{"given":"Gareth","family":"Hughes","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ed","family":"Moran","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J","family":"Dedicoat","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"2025082622522025000_12.12.e229380.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"2025082622522025000_12.12.e229380.2","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1053\/bean.2001.0165","article-title":"History of nitrous oxide\u2014with special reference to its early use in Germany","volume":"15","author":"Goerig","year":"2001","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"2025082622522025000_12.12.e229380.3","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"2025082622522025000_12.12.e229380.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8801-3"},{"key":"2025082622522025000_12.12.e229380.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-017-0990-3","article-title":"Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review","volume":"17","author":"Yuan","year":"2017","journal-title":"BMC Neurol"},{"key":"2025082622522025000_12.12.e229380.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2016-215728","article-title":"Nitrous oxide misuse and vitamin B12 deficiency","volume":"2016","author":"Massey","year":"2016","journal-title":"BMJ Case Rep"},{"key":"2025082622522025000_12.12.e229380.7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/2249-4863.152276","article-title":"Vitamin B12 and vitamin D deficiencies: an unusual cause of fever, severe hemolytic anemia and thrombocytopenia","volume":"4","author":"Mishra","year":"2015","journal-title":"J Fam Med Primary Care"},{"key":"2025082622522025000_12.12.e229380.8","first-page":"OD01","article-title":"A curious case of fever and hyperpigmentation","volume":"9","author":"Chakrabarti","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"2025082622522025000_12.12.e229380.9","first-page":"304","article-title":"Is nitrous oxide really that joyful?","volume":"75","author":"Glijn","year":"2017","journal-title":"Neth J Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:52:29Z","timestamp":1756273949000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":9,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12,2]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/bcr-2019-229380"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229380","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,12]]}}}