heroin and Cerebrovascular-Disorders

The spectrum of neurological complications associated with heroin addiction has changed in the past six years because of the progressive knowledge of the neurological complications related to HIV infection. We reviewed 48 heroin addicts with neurological complications and 452 heroin overdose who were seen in the Emergency Unit of our hospital during 1988 and the publications since 1967. Regarding the overdose we present the results of a prospective study leading to determine the causes. We emphasize the relationship with the level of total morphine in serum, instead of conjugate morphine, and with the presence of high levels of benzodiazepines found in the plasma rather than an hypothetic hypersensitivity phenomenon. We resume the neurological complications related with heroin addiction: spongiform leukoencephalopathy, epileptic seizures, stroke, transverse myelopathy and neuromuscular complications such mononeuropathy, plexopathy, acute inflammatory demyelinating polyradiculoneuropathy, rhabdomyolysis, fibrosing myopathy, musculoskeletal syndrome and acute bacterial myopathy. Some of such complications (i.e. transverse myelitis, polyradiculoneuropathy, leucoencephalopathy) must rise the suspicion of an HIV infection. Likewise, in patients assisted for overdosage we believe it's necessary rule out myoglobinuria by means of CPK serum levels and detection of urine hematic pigments without red blood cels in the urine sediment, in order to prevent and treat the renal failure. We report the results of muscular biopsy found in the musculoskeletal syndrome, which are similar to those found in alcoholic myopathy. Finally, we describe the clinical and diagnostic aspects in an unusually neuromuscular complication: the acute bacterial myopathy.

Topics: Cerebrovascular Disorders; Coma; Drug Overdose; Epilepsy; Heroin; Heroin Dependence; Humans; Leukoencephalopathy, Progressive Multifocal; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; Peripheral Nervous System Diseases

Topics: Abscess; Adult; Animals; Autopsy; Blindness; Brain Diseases; Cerebrovascular Disorders; Endocarditis; Haplorhini; Hepatitis A; Heroin; Heroin Dependence; Humans; Male; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; New York City; Peripheral Nervous System Diseases; Quinine; Substance-Related Disorders; Tetanus

Two heroin addicts, aged 30 and 35 years, developed severe ischemic stroke shortly after intravenous injection of heroin. Arteriograms, CT-scans, and Technesium-99 scintigrams demonstrated non-occlusive extensive infarctions in the carotid territory. Cerebral blood flow investigation in one showed severe hyperemia of the entire left carotid artery territory, including areas, where infarction did not develop. Stroke was not due to arterial occlusion. It was more likely due to generalized hypoxia combined with decreased perfusion pressure in the carotid territory on one site because of external compression of the carotid artery during the intoxicated comatose state.

Topics: Adult; Cerebrovascular Disorders; Female; Heroin; Humans; Male; Radionuclide Imaging; Substance Abuse, Intravenous; Substance-Related Disorders

Topics: Adult; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Cerebrovascular Disorders; Drug Hypersensitivity; Electroencephalography; Female; Hemiplegia; Heroin; Humans; Substance-Related Disorders