{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:40:05Z","timestamp":1756287605748,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,3]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Nitrous oxide (NO) is an inhalant that has become increasingly popular as a recreational drug. While it is presumed to be harmless, a number of adverse effects of NO have been described. We discuss the case of a 24-year-old man with no medical history, who initially presented to the emergency department with progressive polyneuropathy caused by vitamin B<jats:sub>12<\/jats:sub> deficiency after NO abuse. Two days after being discharged with hydroxocobalamin supplementation, the patient returned with a severe headache, blurry vision and slurred speech. Imaging revealed cerebral venous sinus thrombosis. Hypercoagulability workup showed slightly elevated homocysteine and normalised vitamin B<jats:sub>12<\/jats:sub> after supplementation. Genetic testing showed a heterozygous prothrombin G20210A mutation. He was treated with low-molecular-weight heparin followed by dabigatran. We hypothesise that NO use may increase the risk of developing cerebral venous thrombosis, especially in patients with multiple risk factors and elevated homocysteine levels.<\/jats:p>","DOI":"10.1136\/bcr-2021-244478","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T13:02:51Z","timestamp":1629118971000},"page":"e244478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Cerebral venous sinus thrombosis: a complication of nitrous oxide abuse"],"prefix":"10.1136","volume":"14","author":[{"given":"Laura","family":"de Valck","sequence":"first","affiliation":[{"name":"Neurology, Zuyderland Medisch Centrum Sittard-Geleen, Sittard-Geleen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria Margarita","family":"Defelippe","sequence":"additional","affiliation":[{"name":"Neurology, Zuyderland Medisch Centrum Sittard-Geleen, Sittard-Geleen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalia Anne Maria Geertruida","family":"Bouwman","sequence":"additional","affiliation":[{"name":"Neurology, Zuyderland Medisch Centrum Sittard-Geleen, Sittard-Geleen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"2025082702115961000_14.8.e244478.1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"2025082702115961000_14.8.e244478.2","unstructured":"Winstock AR , Barratt MJ , Maier LJ . Global drug survey (GDS) 2019 key findings report, 2019. Available: https:\/\/www.globaldrugsurvey.com\/gds-2019\/ [Accessed Mar 2021]."},{"key":"2025082702115961000_14.8.e244478.3","unstructured":"Winstock AR , Barratt MJ , Maier LJ . Global drug survey (GDS) 2014 key findings report, 2014. 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