Intraparenchymal hemorrhage after heroin use.
*Heroin Dependence; Adult; Cerebral Hemorrhage/*chemically induced/diagnostic imaging; Female; Heroin/*adverse effects; Humans; Narcotics/*adverse effects; Radiography; Stroke/*chemically induced/diagnostic imaging
Heroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment. During ambulance transport, she endorsed heroin use. The patient was alert but could not recall her name, place, or time. She intermittently responded "I don't know" to questioning and could not perform simple commands. No motor or sensory deficits were apparent other than sluggish pinpoint pupils. There were no signs of trauma other than antecubital track marks. Her laboratory results were unremarkable. Reevaluation at 2 hours after presentation showed persistent confusion and disorientation. A computed tomographic scan of the head was obtained, which showed a large 5.1 x 5-cm intraparenchymal hemorrhage in the left frontal lobe, vasogenic edema, and a 5-mm midline shift. A workup for cardioembolic, vasculitis, and other etiologies for stroke did not reveal an underlying cause. The patient remained confused with significant memory loss throughout her hospital stay and was eventually discharged to a long-term care facility. Drug abuse should be considered a risk factor for stoke in young adults. In patients with persistent neurologic deficits, physicians must be vigilant and order appropriate workup while managing drug overdose.
Kumar Neha; Bhalla Mary Colleen; Frey Jennifer A; Southern Alison
The American journal of emergency medicine
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2015.01.007" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2015.01.007</a>
Substantia nigra MR imaging signal changes and cardiomyopathy following prenatal exposure to cocaine and heroin.
Female; Humans; Infant; Pregnancy; *Magnetic Resonance Imaging; Heroin/*adverse effects; Narcotics/*adverse effects; *Prenatal Exposure Delayed Effects; Child Development/drug effects; Cocaine/*adverse effects; Failure to Thrive/chemically induced/etiology; Substance-Related Disorders/*diagnosis/etiology; Substantia Nigra/drug effects/*pathology; Cardiomyopathy; Dilated/chemically induced/*diagnosis
Exposure to cocaine in utero results in behavioral and neurodevelopmental abnormalities that persist into adulthood. Conventional MR imaging has generally failed to reveal the expected structural lesions to explain these clinical findings. We report a case of focal MR imaging signal-intensity changes in the substantia nigra, locus ceruleus, and other selected nerve tracts and nuclei in a child exposed prenatally to cocaine and other drugs. The patient also had dilated cardiomyopathy.
Arnold R; Johnson C; McNulty B; Gaisie G
AJNR. American journal of neuroradiology
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3174/ajnr.A0966" target="_blank" rel="noreferrer noopener">10.3174/ajnr.A0966</a>