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Nitrous oxide is used as an anaesthetic and analgesic agent in the medical setting and is known to cause raised intracranial pressure. The use of nitrous oxide recreationally for the drug's euphoric and relaxant properties has been linked to multiple neurological and psychiatric sequelae including neuropathy, myelopathy, and psychosis. We describe a case of a young person who declared heavy nitrous oxide use resulting in vision-threatening papilloedema secondary to raised intracranial pressure. He underwent emergency lumbar drainage alongside high-dose acetazolamide and parenteral vitamin B 12 injections. To our knowledge, there have yet to be other reports of cases where heavy nitrous oxide use has caused secondary pseudotumor cerebri syndrome., Competing Interests: Professor Susan Mollan has received honoria for teaching from Novartis (2019); Chiesi (2020,2021), Heidelberg Engineering (2019, 2020,2021), and Teva (2019, 2021). Professor Mollan has served on advisory boards for Invex Therapeutics Janssen, and Gensight in the last 3 years. Professor Mollan has received payment for consultancy work for Invex therapeutics (2020, 2021, 2023). All other authors have no disclosures to declare. The authors alone are responsible for the content and writing of the paper., (© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.)