Recreational nitrous oxide use causing internal carotid artery thrombus leading to ischemic stroke in a young adult: a case report

Abstract Introduction: The recreational use of nitrous oxide (N2O) is on the rise and users increasingly present to emergency services with a wide range of – mostly neurological – complications. Case presentation: We describe a very rare case of a 22-year-old male who sporadically uses N2O and presented to the emergency department with a large right-hemispheric stroke caused by a thrombus in the right internal carotid artery. After thorough exclusion of other causes, the underlying mechanism was found to be N2O-induced hyperhomocysteinemia. Conclusion: Ischemic stroke should be considered in N2O users presenting with acute neurological deficits, especially when lateralization is present. Conversely, young stroke patients should be specifically questioned about N2O use and homocysteine levels should be obtained. These recommendations have therapeutic implications both in the acute phase and thereafter.