heroin and Spinal-Cord-Diseases

The neurological complications observed in 6 HIV negative intravenous drug users are reported. Four developed acute neuromuscular involvement in a lumbosacral or brachial distribution with rhabdomyolysis, myoglobinuria, hypovolemia, renal and hepatic failure in the 3 most severely affected patients. Despite evidence of immunologic abnormalities and especially presence of anti-heroin antibodies, we feel that causative mechanisms include mixed compression and ischemia with an underlying toxic myopathy, resulting in segmental myopathy with secondary compression of peripheral nerves. Two patients developed myelopathy with acute or chronic onset. The mechanisms were vascular with spinal cord infarction in the acute form and probably infectious with secondary compressive arachnoiditis in the chronic form. In these 2 patients with myelopathy, outcome was poor.

Topics: Acute Disease; Adult; Chronic Disease; Heroin; Humans; Male; Neuromuscular Diseases; Spinal Cord Diseases; Substance Abuse, Intravenous

As the opioid epidemic continues, understanding manifestations of abuse, including heroin-associated myelopathy remains essential. Here we describe a young man with a past medical history significant for polysubstance abuse who developed acute-onset, rapidly progressive myelopathy after resumption of intravenous heroin use. He had significant spinal cord involvement with findings suggestive of heroin-associated myelopathy. The salient features of this case include diffusion imaging of the spine and spinal angiography supporting a possible vasculopathy as the pathophysiologic mechanism underlying heroin-associated myelopathy. Additionally, CSF studies showed the transition from a neutrophilic pleocytosis to a lymphocytic pleocytosis suggesting an inflammatory component.

Topics: Acute Disease; Adult; Disease Progression; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Paraplegia; Spinal Cord Diseases

A man aged 33 years with previous heroin substance abuse was found unconscious lying in a bush. The patient had been without heroin for some time but had just started to use intravenous heroin again, 0.5-2 g daily. The patient had almost complete paraplegia and a sensory loss for all modalities below the mamillary level and a urine retention of 1.5 L. Acute MRI of the spine revealed an expanded spinal cord with increased intramedullary signal intensity, extending from C7-T9. The cerebrospinal fluid showed extremely high levels of nerve injury markers particularly glial fibrillar acidic protein (GFAP): 2 610 000/ng/L (ref. <750). The patient was empirically treated with intravenous 1 g methylprednisolone daily for 5 days and improved markedly. Very few diseases are known to produce such high levels of GFAP, indicating a toxic effect on astrocytes. Measuring GFAP could possibly aid in the diagnosis of heroin-induced myelopathy.

Topics: Acute Disease; Adult; Astrocytes; Biomarkers; Drug Users; Glial Fibrillary Acidic Protein; Heroin; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Paraplegia; Sensation Disorders; Spinal Cord; Spinal Cord Diseases; Substance Abuse, Intravenous

Topics: Acute Disease; Administration, Inhalation; Adolescent; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Lumbosacral Region; Magnetic Resonance Imaging; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Paraplegia; Spinal Cord Diseases

Topics: Heroin; Heroin Dependence; Humans; Spinal Cord Diseases

Topics: Administration, Inhalation; Heroin; Magnetic Resonance Imaging; Medulla Oblongata; Narcotics; Spinal Cord Diseases; Spine

Topics: Administration, Inhalation; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paraplegia; Spinal Cord; Spinal Cord Diseases

Description of a case of benign acute transverse myelopathy in a young woman who had taken heroin I.V. after a two-year free interval. Spinal angiography was negative but CT scanning of the cord showed a swelling at C3.

Topics: Acute Disease; Adult; Drug Hypersensitivity; Female; Heroin; Humans; Hypesthesia; Injections, Intravenous; Paraplegia; Spinal Cord Diseases; Substance Withdrawal Syndrome

The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.

Topics: Abscess; Anti-Bacterial Agents; Cefazolin; Cocaine; Duodenal Ulcer; Heroin; Humans; Kidney Failure, Chronic; Male; Meninges; Methicillin; Middle Aged; Myelography; Oxacillin; Renal Dialysis; Spinal Cord Diseases; Staphylococcal Infections; Staphylococcus aureus; Subdural Space; Substance-Related Disorders

Topics: Adult; Brain Diseases; Deglutition Disorders; Dexamethasone; Drug Hypersensitivity; Heroin; Humans; Male; Pons; Quadriplegia; Speech Disorders; Spinal Cord Diseases; Substance-Related Disorders