ACUTE HIPPOCAMPAL SCLEROSIS FOLLOWING ECSTASY INGESTION

Abstract

We report 2 patients presenting with brief tonic-clonic seizures following ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) ingestion who initially showed hippocampal swelling and subsequently atrophy. ### Case reports. #### Case 1. A 25-year-old right-handed man presented following 2 generalized tonic-clonic seizures (GTCS). The first, lasting 30 seconds, occurred 5 hours after taking 2 ecstasy tablets and 8 units of alcohol. The following day he felt unwell and vomited several times but his partner did not report any other unusual behaviors until the afternoon when he had a further 2-minute GTCS, and presented to hospital. In the days prior to the ecstasy ingestion, he had been well. There was no past history or family history of seizures. There was a history of IV heroin and amphetamine use from age 17 until 22. More recently, he used ecstasy, approximately “half a tablet” every few months. Examination revealed the patient to be oriented, agitated, and febrile (38.5°C), but with no focal neurologic deficits and no neck stiffness. Investigations revealed renal impairment (serum creatinine 213 mmol/L; normal range 30-110 mmol/L), but otherwise normal electrolytes (serum sodium 139 mmol/L). There was leucocytosis (white cell count 19.0 × 106/L, lymphocytes 16.3 × 106/L; normal ranges 4-11 and 2-7.5 × 106/L). C-reactive protein was 9 mg/L (normal <8 mg/L). Cerebral CT was unremarkable. Chest x-ray, urine, and blood …