Student Competition (Knowledge Generation) ID 1984525

IF 2.4 Q1 REHABILITATION
Nicholas Sequeira, B. C. Craven
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引用次数: 0

Abstract

Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.
学生竞赛(知识生成) ID 1984525
使用海洛因导致药物诱发脊髓病的报道很多,但使用苯丙胺或芬太尼导致药物诱发脊髓病的报道较少。高血糖诱发的急性脊髓病以前尚未见报道。 我们介绍了一例因上述结果而继发中毒性/代谢性脊髓病的病例,患者前来接受三级住院康复治疗。 一名 28 岁的男性患者患有 1 型糖尿病,无并发症,曾使用多种药物(芬太尼和冰毒),因四肢瘫痪和麻醉入院。患者称,他在使用毒品时从楼梯上摔下,醒来时已严重瘫痪,在地上躺了数小时至数天。初步检查显示其运动水平为 C5。全景 CT 显示颅内或脊柱无异常。磁共振钆成像显示,C1-T4脊髓水肿,C4-C7脊髓斑片状强化,但无脊髓受压。随后在 C4-C7 出现弥散受限和出血转化。初始血糖为 66,无血清酮体。血清毒物检测呈阴性,尿液毒物检测呈苯丙胺和芬太尼阳性。自身免疫和感染检查结果均为阴性。他接受了 5 天的脉冲类固醇治疗和 7 个疗程的血浆置换术,但功能和神经系统改善甚微。他作为 C5 AIS-B 级患者入院进行康复治疗,在积极的住院康复治疗 3 个月后,运动或感觉功能没有进一步改善。 考虑到出血性转化的脊髓强化模式,这种损伤很可能是由高血糖和安非他明/芬太尼诱发的急性脊髓炎。据我们所知,这是第一例高血糖可能导致急性脊髓炎的病例报告。
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来源期刊
CiteScore
3.20
自引率
3.40%
发文量
33
期刊介绍: Now in our 22nd year as the leading interdisciplinary journal of SCI rehabilitation techniques and care. TSCIR is peer-reviewed, practical, and features one key topic per issue. Published topics include: mobility, sexuality, genitourinary, functional assessment, skin care, psychosocial, high tetraplegia, physical activity, pediatric, FES, sci/tbi, electronic medicine, orthotics, secondary conditions, research, aging, legal issues, women & sci, pain, environmental effects, life care planning
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