Acute Demyelination in a Person with Amphetamine Abuse

Abstract

We report the case of a 31-year-old woman, admitted to the hospital for chest pain, dying a few days later from septic multiorgan failure, and showing at autopsy foci of acute demyelination in the occipital lobe. Gas chromatography/mass spectrometry analysis revealed the presence of amphetamine in the demyelinated area, which might be considered as the pathogenic agent, since other causes for demyelination could be excluded. This case represents the first report showing a demyelinating process due to a street drug.

Illicit Sympathomimetic Drug Abuse in Demyelinating Diseases

“…Our last patient presented with recurrent encephalopathy and markedly increased pleocytosis. In spite the patient having the most severe pleocytosis, all Spinal taps were negative of OCBs and the MR hyperintensities were neither diagnostic of MS nor ADEM, but revealed neuroimaging features previously described in cocaine associated leukoencephalopathy [13,[19][20][21]. It might be possible that sympathomimeticinduced leukoencephalopathy is a disease entity of its own.…”

“…It might be possible that sympathomimeticinduced leukoencephalopathy is a disease entity of its own. A monosymptomatic fatal course and radiological features demonstrating symmetric leukoencephalopathy could support this notion [13,16,[19][20][21]. However, the presence of WML fulfilling McDonald criteria with positive OCB suggests CIS or MS.…”

“…Of note, no evidence of vasculitis was present in the cases. Weis et al demonstrated sharply demarcated demyelination, perivascular but not vasculitic inflammation, HLA DR II positive macrophage infiltration, reactive astrogliosis and relative axonal sparing, all features consistent with inflammatory demyelination [21]. Furthermore, they detected the presence of amphetamine within the demyelinated lesion using gas chromatography and mass spectroscopy.…”

“…Several studies have highlighted the severity of leukoencephalopathy in cocaine abusers [10][11][12], and few studies found symptomatic MRI lesions in cocaine users [13][14][15][16][17][18][19][20] and amphetamine users [21,22]. Ryan et al [20] demonstrated myelin pallor, macrophage infiltration, axonal spheroid formation with relative axonal sparing and amyloid precursor protein deposition (an immunohistochemical marker of acute axonal injury), all histological features which may be consistent with inflammatory demyelination.…”

Ιστοπαθολογικές Αλλοιώσεις Των Εγκεφαλικών Αγγείων Συνεπεία Χρήσης Τοξικών Ουσιών

“…Δπηπιένλ, νη ακθεηακίλεο αληρλεχηεθαλ κφλν ζηηο εζηίεο απνκπειίλσζεο θαη φρη ζηηο εγγχο ή πην απνκαθξπζκέλεο πεξηνρέο ηνπ εγθεθάινπ. Απηή ήηαλ ε πξψηε αλαθνξά κηα δηαδηθαζίαο απνκπειίλσζεο εμαηηίαο κηαο λαξθσηηθήο νπζίαο (Weis, 2011).…”