Bilateral pan-plexus lesion after substance use: A case report

Area of Science:

• Neurology
• Toxicology

Background:

• Peripheral nervous system complications, including acute demyelinating polyradiculopathy and mononeuropathy, are rare but recognized sequelae of substance use.
• Substance abuse is a potential, though infrequently considered, cause of non-traumatic neurological deficits.

Observation:

• A 27-year-old male presented with symptoms suggestive of rhabdomyolysis following illicit drug use.
• The patient developed generalized edema and "flask paralysis" in both upper limbs by Day 4.
• Electrophysiological studies confirmed bilateral brachial pan-plexopathy.

Findings:

• Rhabdomyolysis, indicated by elevated muscle enzymes and myoglobin, was identified as the underlying cause.
• The patient underwent a rehabilitation program for the diagnosed bilateral brachial pan-plexopathy.
• Significant electrophysiological recovery was observed in most upper limb muscles after eight months, with residual deficits in specific hand muscles.

Implications:

• This case highlights the critical need to investigate substance use in patients presenting with non-traumatic plexopathy.
• Early recognition of drug-induced rhabdomyolysis and subsequent neuropathy is essential for timely intervention.
• Understanding the link between substance abuse and peripheral nerve damage can improve diagnostic accuracy and patient outcomes.