[Plexus lesions, rhabdomyolysis and heroin]

Of five patients admitted to hospital after heroin injection, three had injected heroin exclusively, and two had taken several other drugs orally in addition to heroin. All patients developed severe rhabdomyolysis as well as lesions of the brachial or lumbosacral plexus or both, affecting more than one extremity in three cases. The neurologic symptomatology occurred with variable latency after heroin injection. Additionally, one patient presented a bilateral compartment syndrome in the lower extremities. While CK values normalized within 2-3 weeks, even severe pareses markedly improved within only a few months. Current knowledge of these complications is summarized from the literature and several pathophysiological hypotheses are derived from the present case histories. In the light of theoretical considerations and our own observations of comparable clinical features in patients who had not consumed opiates, the question arises whether the syndrome is heroin specific or not.