Transcript Neurological Complications of Heroin

Neurological Complications of
Heroin
Case Study
Department of Neurology
Alfred Hospital
26 April, 2000.
Presentation
P. G.
17 year old boy
sudden onset
quadraparesis, beginning at the C7/8
myotome,
Decreased pinprick/pain/temperature
sensation over right limbs and right side of
torso
Background of regular IV heroin use.
Past History:
IVDU
Hep C
Social History:
Under Department of Human services
Mother lives in Darwin
Limited contact with father
History of presenting
complaint
25/2/00: Hit of heroin whilst at home at 22:00.
Lay on the couch with head hyperextended over the armrest
of the couch.
Awoke several hours later unable to move.
Crawled around room, then fell asleep on the floor.
26/2/00: Awoke early, still unable to move
Ambulance called  The Alfred
On arrival:
Unable to move both hands/legs
Acute urinary retention 1.5L
Examination findings
Part I
Cranial nerves intact
Peripheral neurological examination:
Upper: Decreased power 2/5 from the level of C7
myotome
Decreased pin prick and pain sensation beginning C7
dermatome on the right ( C6, 7 on the left solely)
Normal biceps reflex, decreased supinator & triceps
jerk bilaterally
Lower: Flaccid on presentation
Paraparesis 2+/5 all muscle groups
Knee jerks: initially decreased
Plantars up going bilaterally
Examination findings
Part II
Cardiovascular examination:
No murmurs
No evidence of endocarditis
Residual volume: 1,100mls  catheterised
Progress
Part I
Investigated to exclude differential diagnostic considerations:
Demyelination
Vasculitis
Cardioembolic phenomenon
Heroin induced myelopathy
Evolving spasticity in lower limbs
Ambulating without assistance
Catheter removed : residual volume of 140 mls
Progress
Part II
Planned transfer to Royal Talbot for continued rehabilitation:
Patient discharged himself against medical advice
Outpatient physiotherapy &ongoing drug counselling
arranged through Royal Talbot in May.
Follow up meeting with DHS 1/52 following discharge 
patient using heroin again
Investigations
U&E: 137/4/4.5/0.07
FBE: 157/9.92/308
Vasculitic screen (ENA,ANA, ANCA, Lupus inhibitor screen,
cryoglobulin, ACE –ve)
Demyelination: serum electrophoresis NAD
CSF: Clear and colourless, glucose 2.8 (serum 4), protein
0.74, negative oligoclonal bands
HIV: -ve
TOE: NAD
CK: 7000 peak
Thank You