RESUMEN
In summary, these data suggest that widespread primary or secondary cerebral vasoconstriction is common in patients with neurological complications from cocaine. In most patients, SPECT showed wide-spread hypoperfusion in regions that had no clear clinical significance (e.g., the periventricular area). In many, the SPECT was performed more than 24 hours after the onset of neurological symptomatology. These findings raise several questions. It has been assumed that these SPECT changes in patients with acute neurological symptoms are temporary, although it will be important to determine whether these areas of hypoperfusion persist after symptoms have abated. Recently, Holman and colleagues (1991) found multifocal and deep areas of hypoperfusion with SPECT in 16 of 18 patients with a history of chronic cocaine abuse. Although most of the subjects tested positive for cocaine, several had abstained from cocaine use for weeks prior to the study. All 18 subjects had neuropsychological deficits, 13 mild and 5 moderate. Similarly, Pascual-Leone and colleagues (1991) have shown that CT scan atrophy strongly correlates with the duration of cocaine abuse, suggesting that brain injury may occur with continued use of cocaine. It is the authors' concern that cocaine abuse might produce permanent changes in cerebral perfusion. In conclusion, brain SPECT was found to be a useful procedure in the evaluation of acute cocaine intoxication. Brain SPECT revealed focal cortical lesions not seen on head CT or MRI, which corresponded to clinical deficits. In addition, [99mTc]HMPAO brain SPECT had a characteristic scalloped appearance, and this may be a marker for acute intoxication with cocaine. This study further supports the contention that cocaine causes neurological disease by its vasoconstrictive action.
Asunto(s)
Circulación Cerebrovascular/efectos de los fármacos , Cocaína/envenenamiento , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/etiología , Urgencias Médicas , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Convulsiones/diagnóstico , Convulsiones/etiología , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
Cocaine causes serious neurologic and neuropsychiatric complications. Cocaine-induced seizures are common and appear to be due to the local anaesthetic actions of this compound. Cocaine induced stroke has varied mechanisms. With ischemic stroke there is severe vasospasm induced by rises in brain catecholamines. These changes can persist for many weeks and can be demonstrated using single-photon emission computerized tomography (SPECT). In many patients with psychiatric symptoms such as psychosis or mania, SPECT demonstrates similar changes in cerebral blood flow. In fact, some of the psychiatric symptoms induced by cocaine may be due to decreases in cerebral blood flow. In cocaine abuse, treatment strategies based on decreasing cerebral vasospasm need to be developed.
Asunto(s)
Encéfalo/efectos de los fármacos , Cocaína/efectos adversos , Psicosis Inducidas por Sustancias , Tomografía Computarizada de Emisión de Fotón Único , Trastorno Bipolar/inducido químicamente , Encéfalo/patología , Encéfalo/fisiopatología , Catecolaminas/análisis , Catecolaminas/farmacocinética , Trastornos Cerebrovasculares/inducido químicamente , Femenino , Humanos , Masculino , Convulsiones/inducido químicamenteRESUMEN
We report on the use of Tc-99m hexamethylpropylene amineoxime (HMPAO) in watershed infarcts in five patients who had focal neurologic symptoms. Good correlation between Tc-99m HMPAO and CT was found in two patients. In three patients only Tc-99m HMPAO SPECT in a watershed distribution showed a perfusion abnormality that explained the clinical findings. Tc-99m HMPAO SPECT may be more sensitive than CT in the detection of infarctions in the watershed distribution.
Asunto(s)
Infarto Cerebral/diagnóstico , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Exametazima de Tecnecio Tc 99mRESUMEN
The case of a patient who repeatedly injected himself intravenously with elementary mercury in suicide attempts is presented and the toxicological effects of this chemical form and route of exposure of mercury are examined. A review of the literature reveals that elemental mercury, when injected as opposed to inhaled, causes few of the effects typical of mercurialism; pleuritic chest pain was frequently reported, whereas renal and central nervous system involvement were less common. Evidence of premorbid psychiatric disturbances was found in ten of fourteen non-cardiac catheterization exposures to intravenous elemental mercury. Findings in our patient were consistent with these observations. One additional and noteworthy finding in our case was that documented deposits of elemental mercury in the right parietal lobe of the brain did not correlate with any specific deficits on neuropsychological testing. Consultation-liaison psychiatry plays an important role in the treatment and care of these complex patients.
Asunto(s)
Mercurio/administración & dosificación , Intento de Suicidio , Adolescente , Adulto , Dolor en el Pecho/inducido químicamente , Niño , Preescolar , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Intoxicación por Mercurio/complicaciones , Lóbulo Parietal/efectos de los fármacosRESUMEN
11 women with a clinical diagnosis of Premenstrual Syndrome (PMS) and 10 control women with no such diagnosis were compared on pain threshold and pain-tolerance measures in the intermenstrual and premenstrual phases of their menstrual cycles. No significant differences were found between the groups for behavioral measures of pain sensitivity. Ratings of pain intensity, however, were higher in both phases for the PMS group.