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Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.<\/jats:p>","DOI":"10.1136\/bcr-2023-254727","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T11:45:15Z","timestamp":1701344715000},"page":"e254727","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis"],"prefix":"10.1136","volume":"16","author":[{"given":"Tova Michal","family":"Gardin","sequence":"first","affiliation":[{"name":"Neurology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Yang","sequence":"additional","affiliation":[{"name":"Neurology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J","family":"Moeller","sequence":"additional","affiliation":[{"name":"Neurology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2859-7446","authenticated-orcid":false,"given":"Imran H","family":"Quraishi","sequence":"additional","affiliation":[{"name":"Neurology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"2025082723570265000_16.11.e254727.1","unstructured":"Office for National Statistics . 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