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Acute hyperkinetic syndrome due to ephedrone abuse
Anna Dolgan1, Slawomir Budrewicz, Magdalena Koszewicz
1From the Department of Neurology (AD, SB, MK, KS, MZ, EK-G, RP), and Department of General Radiology, Interventional Radiology and Neuroradiology (BJ), Wroclaw Medical University, Borowska, Wroclaw, Poland.
Journal of Addiction Medicine
|April 4, 2015
Summary
Intravenous ephedrone (methcathinone hydrochloride) abuse can cause manganese poisoning, leading to parkinsonism and hyperkinetic movement disorders. Brain MRI reveals characteristic signal abnormalities in basal ganglia and white matter.
Area of Science:
- Neurology
- Toxicology
- Radiology
Background:
- A novel form of manganese poisoning has emerged, linked to the intravenous administration of self-prepared methcathinone hydrochloride, also known as ephedrone.
- Manganese encephalopathy typically presents as parkinsonism that is resistant to levodopa treatment.
Observation:
- A case study involved a 32-year-old male with a history of drug addiction presenting with acute gait disturbances following ephedrone injections.
- Clinical observations included choreic movements, significant postural instability, and a characteristic "cock-walk" gait.
Findings:
- Brain magnetic resonance imaging (MRI) revealed T1-weighted images with high signal intensity in the basal ganglia and pituitary gland white matter.
- T2-weighted images demonstrated decreased signal intensity, predominantly in the globus pallidus.
- MR spectroscopy indicated reduced levels of N-acetylaspartate and choline in affected brain regions.
Implications:
- The distinctive pattern of MRI findings provides a potential explanation for the unusual clinical presentation, characterized by a predominant hyperkinetic syndrome.
- This case highlights the neurotoxic potential of ephedrone abuse and the importance of recognizing manganese encephalopathy with its specific radiological features.