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Susan P Mollan,1,2 Sehrish NA Momin,3 Pavan S Khatkar,4 Olivia Grech,2 Alex J Sinclair,2,5 Georgios Tsermoulas2,6 1Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK; 2Translational Brain Science, Institute of Metabolism and Systems Research; Birmingham, University of Birmingham, Birmingham, UK; 3Ophthalmology Department, The Aga Khan University Hospital, Karachi, Pakistan; 4Medical School, Imperial College London, London, UK; 5Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK; 6Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UKCorrespondence: Susan P Mollan, Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK, Tel/Fax +44 121 3716912, Email soozmollan@doctors.org.ukAbstract: Cerebrospinal fluid disorders have a wide-ranging impact on vision, headache, cognition and a person’s quality of life. Due to advances in technology and accessibility, intracranial pressure measurement and monitoring, usually managed by neurosurgeons, are being employed more widely in clinical practice. These developments are of direct importance for Ophthalmologists and Neurologists because the ability to readily measure intracranial pressure can aide management decisions. The aim of this review is to present the emerging evidence for intracranial pressure measurement methods and interpretation that is relevant to Neuro-ophthalmologists.Keywords: cerebrospinal fluid, intracranial pressure, intraparenchymal intracranial pressure sensors, lumbar puncture opening pressure, neuro-ophthalmology, non-invasive, telemetric intracranial pressure monitor, pseudotumour cerebri, waveform

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.)