Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoidblack mamba
- 22 April 2017
- journal article
- case report
- Published by BMJ in BMJ Case Reports
Abstract
A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid NM2201, technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.Keywords
This publication has 16 references indexed in Scilit:
- Acute disseminated encephalomyelitisHandbook of Clinical Neurology, 2014
- Acute disseminated encephalomyelitis and other inflammatory demyelinating variantsHandbook of Clinical Neurology, 2014
- A differential diagnosis of central nervous system demyelination: beyond multiple sclerosisZeitschrift für Neurologie, 2011
- The Secret “Spice”: An Undetectable Toxic Cause of SeizureThe Neurohospitalist, 2011
- Pathology of acute disseminated encephalomyelitisTranslational Neuroscience, 2011
- Recurrent leukoencephalopathy in a cocaine abuserNeuroToxicology, 2011
- Acute disseminated encephalomyelitis and its place amongst other acute inflammatory demyelinating CNS disordersJournal of the Neurological Sciences, 2011
- Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in childrenMultiple Sclerosis Journal, 2010
- Clinical study of childhood acute disseminated encephalomyelitis, multiple sclerosis, and acute transverse myelitis in Fukuoka Prefecture, JapanBrain & Development, 2010
- Toxic LeukoencephalopathyThe New England Journal of Medicine, 2001