Introduction There has been an increase in reports of N2O gas misuse with subsequent increase in neurological presentations.

Cases Case 1: 21-year-old female with gradual lower limb weakness and loss of sensation. Case 2: 19-year-old male with ataxia and lower limbs proprioception abnormalities.

Outcome Both cases showed laboratory results of anaemia and functional vit B12 deficiency in addition to radiological evidence of spinal, mainly cervical, demyelination consistent with subacute combined degeneration of the cord (SCD).

Discussion N2O induced SCD is a rising problem, the gas causes vitamin B12 dysfunction leading to demyelination which, with long term misuse, may result in permanent neurological damage. Laboratory results and MRI are helpful in diagnosing SCD. It is treatable if early detected and gas misuse stopped. Further investigation and multidisciplinary collaboration are recommended to properly outline and maybe control this problem.