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Neurological Complications of Heroin Case Study

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

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Neurological Complications of Heroin Case Study

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  1. Neurological Complications of HeroinCase Study Department of Neurology Alfred Hospital 26 April, 2000.

  2. 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.

  3. Past History: • IVDU • Hep C • Social History: • Under Department of Human services • Mother lives in Darwin • Limited contact with father

  4. 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

  5. Examination findingsPart 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

  6. Examination findingsPart II • Cardiovascular examination: • No murmurs • No evidence of endocarditis • Residual volume: 1,100mls  catheterised

  7. ProgressPart 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

  8. ProgressPart 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

  9. 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

  10. Thank You

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