Atypical demyelinating lesions due to synthetic cannabinoids: a case report

Synthetic cannabinoids (SCBs) may cause central nervous system side effects associated with neurological and psychiatric findings. We described a patient with SCBs abuse who presented with confusion. Magnetic Resonance Imaging (MRI) of the brain showed periventricular and subcortical white matter and basal ganglia hyperintensities at T2 and fluid-attenuated inversion recovery sequence with partial rim contrast enhancement on T1-weighted MRI with gadolinium. The patient was treated with high dose methylprednisolone. SCBs can cause serious neurological and psychiatric symptoms. Due to lack of knowledge about these drugs, neuropsychiatric morbidity and mortality are not fully understood.

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1. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet 2003; 42:327-360.

2. Mannucci C, Navarra M, Calapai F, Spagnolo EV, Busardò FP, Cas RD, et al. Neurological aspects of medical use of cannabidiol. CNS Neurol Disord Drug Targets 2017; 16:541-553.

3. Thanvi BR, Treadwell SD. Cannabis and stroke: is there a link? Postgrad Med J 2009; 85:80-83.

4. Goyal H, Awad HH, Ghali JK. Role of cannabis in cardiovascular disorders. J Thorac Dis 2017; 9:2079-2092.

5. Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and chronic effects of cannabinoids on human cognition-a systematic review. Biol Psychiatry 2016; 79:557-567

.6. Battistella G, Fornari E, Annoni JM, Chtioui H, Dao K, Fabritius M, et al. Long-term effects of cannabis on brain structure. Neuropsychopharmacology 2014; 39:2041-2048.

7. Zawilska JB. “Legal Highs”--An Emerging Epidemic of Novel Psychoactive Substances. Int Rev Neurobiol 2015; 120:273-300.

8. Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol 2018; 84:2477-2482.

9. Singh R, Saini M. Toxic leucoencephalopathy after ‘chasing the dragon’. Singapore Med J 2015; 56:e102-104.

10. Bianco F, Iacovelli E, Tinelli E, Lepre C, Pauri F. Recurrent leukoencephalopathy in a cocaine abuser. Neurotoxicology 2011; 32:410-412.

11. Ginat DT. MRI of toxic leukoencephalopathy syndrome associated with methylenedioxymethamphetamine. Neurology 2015; 84:757.

12. Filley CM, Kleinschmidt-DeMasters BK. Toxic leukoencephalopathy. N Engl J Med 2001; 34:425-432.

13. Samra K, Boon IS, Packer G, Jacob S. Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoid black mamba. BMJ Case Rep 2017; 2017:bcr2016218431.

14. Scolding N. Acute disseminated encephalomyelitis and other inflammatory demyelinating variants. Handb Clin Neurol 2014; 122:601-611.

15. Kluger B, Triolo P, Jones W, Jankovic J. The therapeutic potential of cannabinoids for movement disorders. Mov Disord 2015; 30:313-327.

16. Kak M, Mikhail F, Yano ST, Guan R, Lukas RV. Buzz Juice: Neurological sequelae of synthetic cannabinoids. J Clin Neurosci 2017; 37:43.

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