Case Presentation: This report describes a case of acute severe myelopathy attributed to nitrous oxide abuse in a 30-year-old patient presenting with gait instability.

Background and Clinical Significance: It depicts the challenges of early recognition in a primary care setting, and highlights through an individual patient-centered experience the profound social impacts of nitrous oxide abuse.

Discussion and Conclusions: This case underscores the need for structured diagnostic approaches, interdisciplinary care, and further research to optimize treatment protocols and prevention strategies to warn nitrous oxide-related complications. Finally, this case quotes both key clinical and paraclinical screening indicators to facilitate case identification in emergency and primary care settings.