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Case Presentation A young adult presented to the emergency department with progressive sensory disturbances and weakness in both arms and legs. There were no signs of bladder dysfunction, infection, prior significant medical conditions, or a vegetarian diet. The patient reported recreational nitrous oxide (N₂O) use over the past six months, with approximately 150 applications, several times per week. Clinical and Diagnostic Findings Neurological examination revealed a transverse spinal cord syndrome, with symptoms more pronounced in the lower extremities and a defined sensory level at thoracic segment T8. Magnetic resonance imaging (MRI) of the cervical spine (T2-weighted) demonstrated a long segment of intramedullary hyperintensity from vertebral body C2 to C5. Axial images showed a characteristic inverted “V” pattern in the posterior columns—typical for subacute combined degeneration (SCD) or funicular myelopathy. There was no radiological or clinical evidence of peripheral nerve ...