Neurological Complications of Heroin

Neurological Complications of
Case Study
Department of Neurology
Alfred Hospital
26 April, 2000.
P. G.
17 year old boy
sudden onset
quadraparesis, beginning at the C7/8
Decreased pinprick/pain/temperature
sensation over right limbs and right side of
Background of regular IV heroin use.
Past History:
Hep C
Social History:
Under Department of Human services
Mother lives in Darwin
Limited contact with father
History of presenting
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
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
Part I
Investigated to exclude differential diagnostic considerations:
Cardioembolic phenomenon
Heroin induced myelopathy
Evolving spasticity in lower limbs
Ambulating without assistance
Catheter removed : residual volume of 140 mls
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
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
CK: 7000 peak
Thank You