Disorders of Spinal Cord, Nerve, and Muscle

Toxic neuropathies

Many substances, organic and manufactured, may induce peripheral nerve damage when exposed to them. The expected clinical phenotype is of a distal, sensory or sensorimotor polyneuropathy, often painful, with axonal characteristics on electrodiagnostic and histopathologic analysis. Treatment is limited; often, the only effective management is supportive care and avoidance from or removal of the offending toxin. Fortunately, the majority of toxic neuropathies are self-limited and improves gradually after toxin elimination.

Neurologic complications of substance abuse

In addition to overdose, withdrawal, and addictive behavior, licit and illicit drugs produce a wide range of neurologic complications. Trauma results from intoxication and from violence related to a drug's illegality. Infection, including AIDS, is most often a consequence of parenteral use. Seizures can be secondary to either toxicity or withdrawal. Stroke can be ischemic or hemorrhagic. Persistent cognitive dysfunction affects alcoholics and probably users of other drugs as well. Teratogenicity is better documented for ethanol and tobacco than for illicit drugs. Other complications of recreational drug use include peripheral neuropathy, myelopathy, parkinsonism, leukoencephalopathy, optic atrophy, and cerebellar ataxia.

Acute neurologic complications of drug and alcohol abuse

Recreationally abused substances include both legal and illegal agents, broadly classified as opioids, psychostimulants, sedatives, cannabis (marijuana), hallucinogens, inhalants, dissociative anesthetics (phencyclidine), anticholinergics, ethanol, and tobacco. These substances are associated with an array of neurological emergencies resulting from overdose, withdrawal, and other medical and neurological complications.