Acute progressive paraplegia in heroin-associated myelopathy

Mahoney, Kyle; Romba, Meghan; Gailloud, Philippe; Izbudak, Izlem; Saylor, Deanna

doi:10.1016/j.jocn.2018.02.005

Cited by 11 publications

(15 citation statements)

References 7 publications

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“…The opioid epidemic is a well-known major public health hazard in the United States which makes it essential to understand the life-threatening manifestations of abuse less commonly highlighted, including heroin-induced myelopathy [ 6 ]. Heroin itself is mostly administered intravenously, but other modes of systemic delivery include subcutaneous, intramuscular, or intranasal routes, as Sahni, Garg, Agarwal, and Singh outline [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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%

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

Sidhu¹,

Mekala²,

Ronen³

et al. 2021

Cureus

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“…[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. 33 On MRI, a longitudinally extensive edematous lesion is seen, sometimes with associated contrast enhancement.…”

Section: Heroin-induced Myelopathymentioning

confidence: 99%

“…28,32,34 Diffusion restriction has been reported. 31 Other described locations of T2 hyperintensities include the ventral pons and focal lateral and posterior spinal cord lesions. 33 MRI is normal in some cases.…”

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%

“…3,4 Vessel irregularities on spinal angiography suggestive of vasculopathy may be present. 27,31 Cerebrospinal fluid analysis is usually normal. Pathologically, large necrotic lesions of the spinal cord have been described.…”

Section: Heroin-induced Myelopathymentioning

confidence: 99%

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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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Toxische Myelopathien

Ludolph¹

2019

Klinische Neurologie

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Acute progressive paraplegia in heroin-associated myelopathy

Cited by 11 publications

References 7 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

Toxische Myelopathien

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