Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence

Ivanovski, Trajche; Ibañez, Ana María Espino; Martín, Bernardino Barceló; Muñiz, Isabel Gomila

doi:10.1136/bcr-2018-228335

Cited by 4 publications

(11 citation statements)

References 14 publications

(49 reference statements)

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“…It is usually reported in individuals recently re-exposed to heroin after a variable drug-free period, indicating an immunopathological cause that is presently not well understood. This indicates some sort of sensitization beforehand, which then results in a hypersensitivity reaction on re-exposure to the drug [ 3 , 8 ]. Spinal cord enhancement on MR imaging, as in this case, suggests inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Most notably, patients with acute idiopathic TM and underlying Systemic Lupus Erythematosus (SLE) have been noted to have a great response to one single pulse dose of IV cyclophosphamide. Despite early diagnosis and prompt treatment, heroin-induced myelopathy can lead to acute and complete spinal cord injury with poor longer-term outcomes, as Ivanovski, Espino Ibañez, Barcelo, and Gomila Muñiz suggest [ 8 ]. Such patients with poor longer-term outcomes typically experience complete paraplegia and spinal shock.…”

Section: Discussionmentioning

confidence: 99%

“…Medical therapy should be coupled with adequate multidisciplinary rehabilitation and restoration, including supporting patients to build the quality of life they want: physical health, mental and emotional health, and social and occupational functioning [ 2 ]. The process of addiction recovery is multifaceted and expands far beyond abstinence versus relapse [ 8 ]. Therefore, support must be provided for the establishment of community-based and community-oriented programs for prevention, education, and treatment [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Heroin Relapse "Strikes a Nerve": A Rare Case of Drug-Induced Acute Myelopathy

Sidhu¹,

Mekala²,

Ronen³

et al. 2021

Cureus

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Opioid addiction is a major public health problem. Through a commitment to individualized treatment plans meant to help patients meet personal goals, behavioral therapy can encourage abstinence and help prevent relapses that can have debilitating consequences.This case describes a 31-year-old male with heroin relapse who presented with flaccid quadriparesis as well as loss of sensation below the T2-3 spinal level, loss of rectal tone, and urinary retention. A urine drug screen (UDS) was positive for opiates and amphetamines. Autoimmune serologies were negative. Cerebrospinal fluid (CSF) analysis was negative for any acute ongoing infectious process. Magnetic resonance imaging (MRIs) of the cervical and thoracic spine showed increased intramedullary signals with spinal cord expansion from C2-T2, indicating acute transverse myelitis. Upon completion of the aforementioned workup, idiopathic transverse myelopathy (TM) was diagnosed, and the patient was started on intravenous (IV) methylprednisolone; he also received five sessions of plasmapheresis. By process of elimination, suspicion remained of a diagnosis of opioid-induced myelopathy. The patient showed mild improvement in his original sensory deficits and flaccid quadriplegia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Heroin Relapse "Strikes a Nerve": A Rare Case of Drug-Induced Acute Myelopathy

Sidhu¹,

Mekala²,

Ronen³

et al. 2021

Cureus

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“…In the majority of reported cases, patients become unconscious due to overdosing or simply fall asleep after drug use, and awaken several hours later with a flaccid paraparesis, sensory loss to all modalities below a spinal level, and urinary retention, sometimes associated with pain in the low back, buttocks, and legs. [24][25][26][27][28][29] Because patients usually awaken with the deficits, the exact time course of the disease is difficult to ascertain; in cases when consciousness is retained, symptoms are usually described as arising within hours of using heroin. 30,31 In a minority of cases, symptoms arise within days 32 or even weeks with a subacute progression.…”

Section: Heroin-induced Myelopathymentioning

confidence: 99%

“…Use of immunotherapy (e.g., high-dose intravenous steroids or plasmapheresis) has been reported in individual cases with a range of outcomes, from no improvement to substantial improvement. 29,31,32,34 Acute Myelopathy Due to an Environmental Exposure…”

Section: Heroin-induced Myelopathymentioning

confidence: 99%

Metabolic and Toxic Myelopathies

Slama

Berkowitz

2021

Semin Neurol

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Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.

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Metabolic and Toxic Myelopathies

Parks¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW This article describes the clinical presentation, relevant diagnostic investigations, and treatment of metabolic and toxic myelopathies. RECENT FINDINGS Metabolic myelopathies, including those due to deficiency of vitamin B12, folate, copper, or vitamin E, are preventable and typically respond to supplementation. In metabolic myelopathy, early recognition and treatment are important to reduce morbidity, particularly due to subacute combined degeneration of the spinal cord. Toxic myelopathies, including those due to medical interventions (eg, methotrexate, radiation), dietary toxins (eg, lathyrism, konzo), and drugs of abuse (eg, heroin), typically result in permanent neurologic deficits. Toxic myelopathy due to hepatic dysfunction may be reversible if patients receive early intervention, whereas nitrous oxide myelopathy responds to vitamin B12 replacement and cessation of exposure. In toxic myelopathy, it is best to avoid the provoking factor when possible or attempt to mitigate risk by identifying risk factors for developing myelopathy. SUMMARY Metabolic and toxic myelopathies are important causes of morbidity that require a high index of suspicion for diagnosis.

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Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence

Cited by 4 publications

References 14 publications

Heroin Relapse "Strikes a Nerve": A Rare Case of Drug-Induced Acute Myelopathy

Heroin Relapse "Strikes a Nerve": A Rare Case of Drug-Induced Acute Myelopathy

Metabolic and Toxic Myelopathies

Metabolic and Toxic Myelopathies

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