‘Legal high’ associated Wallenberg syndrome

Abstract

‘Legal highs’ are substances of synthetic or natural origin having psychotropic properties. ‘Legal highs’ are often new and, in many cases, the actual chemical ingredients in a branded product can be changed without notifications and the risks are unpredictable. Acute recreational drug toxicity is a common reason for presentation to both hospital and prehospital medical services. It appears that, generally, the pattern of toxicity associated with ‘legal highs’ is broadly similar to that seen with classical stimulant recreational drugs such as cocaine, MDMA (3,4 methylenedioxy-N-methyl amphetamine) and amphetamine. Lack of clear literature pertaining to their chemical properties, pharmacology and toxicology makes an evaluation of their effects difficult. We describe a unique case in which consumption of such a substance led to hospital admission and a diagnosis of ‘lateral medullary stroke’ or ‘Wallenberg syndrome’. We believe that this is the first described case of a ‘legal high’ intake linked to a posterior circulation stroke.

Profile, effects, and toxicity of novel psychoactive substances: A systematic review of quantitative studies

“…Studies extracted in this review were from 10 countries (Table ).including Australia (Goggin, Gately, & Bridle, ), France (Eiden et al, ), Italy (Gerace, Petrarulo, Bison, Salomone, & Vincenti, ), Netherland (Hondebrink, Nugteren‐van Lonkhuyze, Van Der Gouwe, & Brunt, , Norway (Karinen, Fosen, Rogde, & Vindenes, ), Poland (Kulhawik & Waleski, ; Rojek, Klys, Strona, Maciow, & Kula, ), Singapore (Winslow & Mahedran, ), Spain (Gonzalez, Ventura, Caudevilla, Torrens, & Farre, ; Papaseit et al, ), the UK (Arora, Kumar, & Raza, ; Dargan & Wood, ; Davies et al, ; Winstock, Mitcheson, Davies, Puchnarewicz, & Marsden, ), and the USA (Antonowicz, Metzger, Sai, & Ramanujan, ; Belton et al ; Borek, Christopher, & Holstege, ; Kelly, ; Spiller, Ryan, Weston, & Jansen, ; Stogner & Miller, ; Lajoie & Rich, ). Most of the studies were retrospective, and fewer were prospective.…”

“…Most of the studies were retrospective, and fewer were prospective. Retrospective studies included audit ( n = 2) (Hondebrink et al, ; Spiller et al, ) and case report ( n = 11; Antonowicz et al, ; Arora et al, ; Belton et al, ; Borek et al, ; Eiden et al, ; Gerace et al, ; Karinen et al, ; Kulhawik & Waleski, ; Rojek et al, ; Lajoie & Rich, ; Winslow & Mahedran, ). Prospective studies included interview/telephone interview ( n = 2) (Kelly, ; Winstock et al, ), observational ( n = 1; Papaseit et al, ) and survey ( n = 4; Goggin et al, ; Gonzalez et al, ; Kelly et al, ; Stogner & Miller, ).…”

“…Forty‐three NPS derivatives were reported in the studies and were used as cognitive enhancers, empactogenic or euphoric agents, hallucinogens, and/or stimulants (Table ). The NPS derivatives were of the following pharmacological classes: cathinones ( n = 18; Antonowicz et al, ; Belton, Sharngoe, Maguire, & Polhemus, ; Eiden et al, ; Gerace et al, ; Gonzalez et al, ; Hondebrink et al, ; Kelly et al, ; Papaseit et al, ; Stogner & Miller, ; Winslow & Mahedran, ), kratom ( n = 1; Karinen et al, ); opioids ( n = 1; Karinen et al, ), ketamines/phenethylamines/piperidine ( n = 9; Gonzalez et al, ; Hondebrink et al, ), Salvia ( n = 2; Kelly, ; Winslow & Mahedran, ), synthetic cannabinoids ( n = 6; Antonowicz et al, ; Arora et al, ; Goggin et al, ; Hondebrink et al, ; Kelly et al, ), and tryptamines ( n = 2; Hondebrink et al, ).…”

“…including Australia (Goggin, Gately, & Bridle, 2015), France FIGURE 1 Data extraction and the study selection process retrospective, and fewer were prospective. Retrospective studies included audit (n = 2) (Hondebrink et al, 2015;Spiller et al, 2011) and case report (n = 11; Antonowicz et al, 2011;Arora et al, 2013;Belton et al, 2013;Borek et al, 2012;Eiden et al, 2013;Gerace et al, 2014;Karinen et al, 2014;Rojek et al, 2012;Winslow & Mahedran, 2014). Prospective studies included interview/telephone interview (n = 2) (Kelly, 2011;Winstock et al, 2011), observational (n = 1; Papaseit et al, 2013) and survey (n = 4; Goggin et al, 2015;Gonzalez et al, 2013;Kelly et al, 2013;.…”