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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Vasculitis is a primary phenomenon in autoimmune diseases such as polyarteritis nodosa, Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, and essential mixed cryoglobulinemia. As a secondary feature vasculitis may complicate, for example, connective tissue diseases, infections, malignancies, and diabetes. Vasculitic neuropathy is a consequence of destruction of the vessel wall and occlusion of the vessel lumen of small epineurial arteries. Sometimes patients present with nonsystemic vasculitic neuropathy, i.e., vasculitis limited to peripheral nerves and muscles with no evidence of further systemic involvement. Treatment with corticosteroids, sometimes in combination with other immunosuppressants, is required to control the inflammatory process and prevent further ischemic nerve damage.
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Affiliation(s)
- Alexander F J E Vrancken
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands
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Esse K, Fossati-Bellani M, Traylor A, Martin-Schild S. Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard. Brain Behav 2011; 1:44-54. [PMID: 22398980 PMCID: PMC3217673 DOI: 10.1002/brb3.7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 05/02/2011] [Indexed: 11/10/2022] Open
Abstract
Drug abuse robs individuals of their jobs, their families, and their free will as they succumb to addiction; but may cost even more: a life of disability or even life lost due to stroke. Many illicit drugs have been linked to major cardiovascular events and other comorbidities, including cocaine, amphetamines, ecstasy, heroin, phencyclidine, lysergic acid diethylamide, and marijuana. This review focuses on available epidemiological data, mechanisms of action, particularly those leading to cerebrovascular events, and it is based on papers published in English in PubMed during 1950 through February 2011. Each drug's unique interactions with the brain and vasculature predispose even young, healthy people to ischemic or hemorrhagic stroke. Cocaine and amphetamines have the strongest association with stroke. However, the level of evidence firmly linking other drugs to stroke pathogenesis is weak. Large epidemiological studies and systematic evaluation of each drug's action on the brain and cardiovascular system are needed to reveal the full impact of drug use on the population.
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Affiliation(s)
- Katherine Esse
- Stroke Program, Department of Neurology, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
- Department of Internal Medicine, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
| | - Marco Fossati-Bellani
- Stroke Program, Department of Neurology, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
| | - Angela Traylor
- Stroke Program, Department of Neurology, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
- Department of Psychiatry & Behavioral Sciences, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
| | - Sheryl Martin-Schild
- Stroke Program, Department of Neurology, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
- Department of Internal Medicine, Tulane University School of Medicine1440 Canal Street, TB-52, Suite 1000, New Orleans, Louisiana 70112-2715
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Stroke and Substance Abuse. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
INTRODUCTION Metamfetamine is a highly addictive amfetamine analog that acts primarily as a central nervous system (CNS) stimulant. The escalating abuse of this drug in recent years has lead to an increasing burden upon health care providers. An understanding of the drug's toxic effects and their medical treatment is therefore essential for the successful management of patients suffering this form of intoxication. AIM The aim of this review is to summarize all main aspects of metamfetamine poisoning including epidemiology, mechanisms of toxicity, toxicokinetics, clinical features, diagnosis, and management. METHODS A summary of the literature on metamfetamine was compiled by systematically searching OVID MEDLINE and ISI Web of Science. Further information was obtained from book chapters, relevant news reports, and web material. Epidemiology. Following its use in the Second World War, metamfetamine gained popularity as an illicit drug in Japan and later the United States. Its manufacture and use has now spread to include East and South-East Asia, North America, Mexico, and Australasia, and its world-wide usage, when combined with amfetamine, exceeds that of all other drugs of abuse except cannabis. Mechanisms of toxicity. Metamfetamine acts principally by stimulating the enhanced release of catecholamines from sympathetic nerve terminals, particularly of dopamine in the mesolimbic, mesocortical, and nigrostriatal pathways. The consequent elevation of intra-synaptic monoamines results in an increased activation of central and peripheral α±- and β-adrenergic postsynaptic receptors. This can cause detrimental neuropsychological, cardiovascular, and other systemic effects, and, following long-term abuse, neuronal apoptosis and nerve terminal degeneration. Toxicokinetics. Metamfetamine is rapidly absorbed and well distributed throughout the body, with extensive distribution across high lipid content tissues such as the blood-brain barrier. In humans the major metabolic pathways are aromatic hydroxylation producing 4-hydroxymetamfetamine and N-demethylation to form amfetamine. Metamfetamine is excreted predominantly in the urine and to a lesser extent by sweating and fecal excretion, with reported terminal half-lives ranging from ∼5 to 30 h. Clinical features. The clinical effects of metamfetamine poisoning can vary widely, depending on dose, route, duration, and frequency of use. They are predominantly characteristic of an acute sympathomimetic toxidrome. Common features reported include tachycardia, hypertension, chest pain, various cardiac dysrhythmias, vasculitis, headache, cerebral hemorrhage, hyperthermia, tachypnea, and violent and aggressive behaviour. Management. Emergency stabilization of vital functions and supportive care is essential. Benzodiazepines alone may adequately relieve agitation, hypertension, tachycardia, psychosis, and seizure, though other specific therapies can also be required for sympathomimetic effects and their associated complications. CONCLUSION Metamfetamine may cause severe sympathomimetic effects in the intoxicated patient. However, with appropriate, symptom-directed supportive care, patients can be expected to make a full recovery.
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Kumar G, Soni CR, Sahota PK. Rapidly resolving pure motor hemiparesis in a healthy young male. J Clin Neurosci 2009. [DOI: 10.1016/j.jocn.2009.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim CT, Dy R, Sollenberger J, Katz E. A Case of Suspected Mononeuritis Multiplex in a Teenager From Polysubstance Abuse. PM R 2009; 1:881-3. [DOI: 10.1016/j.pmrj.2009.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 06/19/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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Latov N, Gorson KC, Brannagan TH, Freeman RL, Apostolski S, Berger AR, Bradley WG, Briani C, Bril V, Busis NA, Cros DP, Dalakas MC, Donofrio PD, Dyck PJB, England JD, Fisher MA, Herrmann DN, Menkes DL, Sahenk Z, Sander HW, Triggs WJ, Vallat JM. Diagnosis and Treatment of Chronic Immune-mediated Neuropathies. J Clin Neuromuscul Dis 2006; 7:141-157. [PMID: 19078800 DOI: 10.1097/01.cnd.0000205575.26451.e4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The chronic autoimmune neuropathies are a diverse group of disorders, whose diagnosis and classification is based on the clinical presentations and results of ancillary tests. In chronic inflammatory demyelinating polyneuropathy, controlled therapeutic trials demonstrated efficacy for intravenous gamma-globulins, corticosteroids, and plasmaphereis. In multifocal motor neuropathy, intravenous gamma-globulins have been shown to be effective. In the other immune-mediated neuropathies, there are no reported controlled therapeutic trials, but efficacy has been reported for some treatments in non-controlled trials on case studies. Choice of therapy in individual cases is based on reported efficacy, as well as severity, progression, coexisting illness, predisposition to developing complications, and potential drug interactions.
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Ryan MM, Tilton A, De Girolami U, Darras BT, Jones HR. Paediatric mononeuritis multiplex: a report of three cases and review of the literature. Neuromuscul Disord 2003; 13:751-6. [PMID: 14561499 DOI: 10.1016/s0960-8966(03)00099-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mononeuritis multiplex results from disease processes causing multifocal injury to the peripheral nerves, with or without involvement of one or more cranial nerves. Most reported cases of paediatric mononeuritis multiplex have been related to autoimmune disorders. We present clinical and neurophysiologic findings in three cases of multiple mononeuropathy occurring in adolescence, with onset at ages 16, 17 and 13 years. Two of these cases were related to systemic vasculitis, one possibly representing a paediatric case of non-systemic vasculitis. Sural nerve biopsy confirmed the diagnosis of vasculitis in one patient with systemic lupus erythematosus, but was non-diagnostic in another case. Mononeuritis multiplex is an extremely uncommon form of acquired peripheral neuropathy in childhood. We discuss the differential diagnosis and review previous descriptions of this rare condition.
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Affiliation(s)
- Monique M Ryan
- Department of Neurology, Children's Hospital, Boston, MA, USA.
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Abstract
DIV is a relatively common cause of inflammatory vasculitis. Drugs from almost every pharmacologic class have been implicated in causing vasculitis in sporadic cases. The level of certainty and quality of evidence for these associations between specific agents and vasculitis vary greatly. The clinical manifestations of DIV range from single organ involvement (most commonly, skin) to life-threatening multiorgan disease. The recently described subset of cases of DIV associated with positive tests for ANCA are an interesting subset of DIV. The diagnosis of DIV is usually one of exclusion. The treatment of DIV is dependent on the severity of disease activity but should always include withdrawal of the suspected drug. If no agent can be implicated, as many drugs as feasible should be discontinued. The necessity of prescribing glucocorticoids or immunosuppressive agents depends on the disease severity and other case-specific information. Increasing understanding of the pathophysiologic characteristics of all inflammatory vasculitides should lead to better diagnostic and therapeutic approaches to DIV.
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Affiliation(s)
- P A Merkel
- Arthritis Center, Boston University School of Medicine, and Rheumatology Section, Boston University Medical Center, Boston, Massachusetts, USA.
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Abstract
The term drug dependence refers to psychic dependence (addiction), physical dependence, or both, in someone who administers a drug periodically or continuously. Recreational drug abusers are at risk for occlusive and hemorrhagic stroke of diverse cause. Although sometimes over diagnosed, cerebral vasculitis has been historically verified in users of legal and illegal drugs.
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Affiliation(s)
- J C Brust
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Abstract
Cocaine use is associated with a variety of serious neurological complications, including cerebral infarction, intracerebral and subarachnoid hemorrhage, transient ischemic attacks, migraines, and seizures. We report two cases of intracerebral hemorrhage with biopsy-proven cerebral vasculitis associated with the use of cocaine. The first case involved a 32-year-old man who presented with headache, left-sided hemiparesis, and severe hypertension and who was found to have a large right putaminal hemorrhage on cranial tomographic (CT) scan. Cerebral angiography did not show vasculitic changes, but brain tissue obtained during hematoma evacuation revealed a nonnecrotizing leukocytoclastic angiitis of the small vessels. The second case involved a 20-year-old man who presented with headache, agitation, and speech difficulty that progressed to disorientation and dysphasia. He had a large left temporoparietal hematoma seen on CT scan. Cerebral angiography was consistent with vasculitis, and brain tissue obtained during hematoma evacuation revealed a small vessel vasculitis. In both cases, thorough clinical and laboratory investigations found no evidence of systemic vasculitis or an etiologic agent other than cocaine. We also critically reviewed the previously reported cases of cocaine-associated cerebral vasculitis and the relevant medical literature to discuss the "cocaine-associated vasculitis syndrome" in the context of more established vasculitidies, including hypersensitivity vasculitis. In addition, we outline a diagnostic and therapeutic approach to patients with possible cocaine-associated vasculitis.
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Affiliation(s)
- P A Merkel
- Department of Medicine, Massachusetts General Hospital, Boston, 02114, USA
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Moore PM. Neurological manifestation of vasculitis: update on immunopathogenic mechanisms and clinical features. Ann Neurol 1995; 37 Suppl 1:S131-41. [PMID: 8968223 DOI: 10.1002/ana.410370713] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Study of the vasculitides illustrates a spectrum of interactions from physiological to pathological between the immune system and the blood-vessel wall. Endothelial cells demonstrably recruit leukocytes by both antigen-specific and antigen-nonspecific mechanisms in the systemic vasculitides. A cascade of cytokine and factors can initiate, perpetuate, and regulate the close interactions of leukocytes and the endothelium. Specific types of leukocytes (neutrophils, T lymphocytes, eosinophils) predominate in the vascular infiltrates of specific diseases. Other mural cells potentially initiate the inflammatory process; this may be particularly important in the central nervous system where regulatory systems may diminish a primary role of the endothelium in vascular inflammation. Neurological abnormalities are a prominent feature of some vasculitides and rare in others. In polyarteritis nodosa, Wegener's granulomatosis, and lymphomatoid granulomatosis neurological features may be prominent and early. The cutaneous vasculitides, hypersensitivity vasculitis, are seldom associated with neurological abnormalities. Isolated angiitis of the central nervous system is notable because it invariably targets the central nervous system and because it must be distinguished from other causes of central nervous system vasculitis, including infections and toxins. In this article we review some of the recent information adding to our knowledge of the immunopathogenic and clinical features in the vasculitides affecting the nervous system.
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Affiliation(s)
- P M Moore
- Department of Neurology, Wayne State University, University Health Center, Detroit, MI 48201, USA
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Abstract
Vasculitis, or angiitis, affects both the central and peripheral nervous systems and is increasingly recognized as a cause of neurologic dysfunction. The vascular inflammation may be systemic or organ restricted. Recent work has expanded our knowledge on the pathogeneses of vasculitis. Historically, immune complex mediated vasculitis is best defined but studies now delineate cell mediated immune mechanisms including T cell and endothelial cell interactions. Additional factors in the genesis of vascular inflammatory diseases are also being explored. There are numerous underlying etiologies ranging from primary immunologic disturbances to infections, malignancies, and toxins. In order to plan rational therapies, clinicians need to be aware of current work on the pathogeneses of vascular inflammation as well as exploring specific etiologies in their individual patients.
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Affiliation(s)
- P M Moore
- Wayne State University, School of Medicine, Department of Neurology, Detroit, MI
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Stoessl AJ, Young GB, Feasby TE. Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics. Stroke 1985; 16:734-6. [PMID: 4024187 DOI: 10.1161/01.str.16.4.734] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report two cases of serious intracerebral haemorrhage occurring in young women following their first use of oral medications containing catecholaminergic agents (phenylpropanolamine in combination with ephedrine or pseudoephedrine). Both women were previously well, and there was no evidence for systemic vasculitis, coagulopathy, aneurysm or arteriovenous malformation. Angiography in both cases, performed approximately forty hours following drug ingestion, revealed the beading pattern typical of that seen in previously reported cases of presumed amphetamine-induced "vasculitis." We believe that this arteriographic abnormality is non-specific and should not be construed as necessarily indicative of arteritis.
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Abstract
When a patient presents with a neurological or neuromuscular disorder, it is essential to consider drugs as a possible cause. Drugs can affect virtually any part of the neuraxis and the resulting disorders can usually be classified in terms of the anatomical site affected and the clinical presentation. In general, the signs and symptoms of drug-induced neurological disorders are virtually indistinguishable from those seen in naturally occurring disease but are usually reversible if diagnosed early enough. Cortical depression may produce coma, particularly in overdose cases, but a large number of drugs can also initiate seizures in susceptible individuals. The effects of drugs in the pathogenesis of headaches are certainly underestimated, and the eye, hearing and balance mechanisms can be severely damaged by certain drugs before symptoms prompt investigation. The long term effects of antipsychotic drugs on basal ganglia demand that these drugs are used only when absolutely essential and for as short a period as possible. Finally, there is increasing awareness of the role of drugs in the development of neuromuscular disorders such as peripheral neuropathies, myasthenic syndromes and myopathies.
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Abstract
The vasculitides are a group of disorders that include the polyarteritis nodosa group of systemic necrotizing vasculitides, hypersensitivity vasculitis, Wegener's granulomatosis, lymphomatoid granulomatosis, giant cell arteritis, Behçet's disease, and isolated angiitis of the central nervous system. Classification is based on clinical, angiographic, and histological features. The frequency and distribution of neurological involvement vary with the underlying disorder and may provide the initial symptoms. Polyarteritis nodosa and Wegener's granulomatosis may affect both the central and peripheral nervous systems, whereas isolated angiitis of the central nervous system and Behçet's disease affect the central nervous system alone. Neurological dysfunction occurs in 80% of patients with polyarteritis nodosa and fewer than 10% of patients with hypersensitivity vasculitis. The mechanism of neurological dysfunction in the vasculitides is tissue ischemia. The clinical effects of ischemia vary, and symptoms may be transient or prolonged. Mononeuritis multiplex, polyneuropathy, and stroke are frequent complications, but encephalopathies, cranial neuropathies, and brachial plexopathies are seen as well. The occurrence of symptoms late in the course of a disease suggests ischemia resulting from healed, scarred vessels as well as from those that are acutely inflamed; this is the case in Takayasu's arteritis and possibly also in polyarteritis nodosa. Treatment is based on identifying and removing the sensitizing agent when possible. Wegener's granulomatosis requires therapy with cyclophosphamide; temporal arteritis, with corticosteroids. In other vasculitides a balance must be reached between the progression of the disease and the side effects of immunosuppression.
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Fan PT, Davis JA, Somer T, Kaplan L, Bluestone R. A clinical approach to systemic vasculitis. Semin Arthritis Rheum 1980; 9:248-304. [PMID: 6105711 DOI: 10.1016/0049-0172(80)90017-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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