Bilateral Basal Ganglia Necrosis Secondary to Methamphetamine.

Abstract

Bilateral basal ganglia hyperintensities observed by MRI are caused by systemic or toxic-metabolic disorders. The most common agents include carbon monoxide, cyanide, methanol, manganese, disulfiram, and hydrogen sulfide.1 A 28-year-old female, 28-weeks pregnant, presented to ER after being discovered unresponsive. Drug paraphernalia were found in the motel room. She was somnolent with no focalizations, diffusely hyperreflexic, and bradykinetic. Track marks were observed on extremities, and her urine toxicology tested positive for amphetamines, methadone, and oxycodone. CSF was not analyzed. Brain MRI revealed bilateral basal ganglia hyperintensities on FLAIR and T2-sequences involving putamen, globus pallidus, and internal and external capsule, suggestive of edema and necrosis (Fig. 1). She was admitted to neurocritical care unit for supportive management. She gradually improved and delivered her baby uneventfully at 38 weeks. She had mild parkinsonism at discharge. Amphetamines are potent sympathomimetics associated with leukoencephalopathy, axonal swelling, cell damage, and even cell death in basal ganglia.2 It is unclear if pregnancy and a possible post-anoxic state introduced an additional layer of vulnerability. Clinicians should consider methamphetamine as a cause of bilateral basal ganglia necrosis and parkinsonism. Additionally, the presence of edema disproportionate to ischemia should alert the clinician to consider the possibility of a toxic effect. 1) Research project: A. Conception, B. Organization, C. Execution; 2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; 3) Manuscript: A. Writing of the first draft, B. Review and Critique. A.S.: 1A, 1B, 2C, 3A, 3B D.M-R.: 1A, 1B, 2C, 3A, 3B A.K.: 3A, 3B K.B.: 3A, 3B T.S.Y.: 3A, 3B N.N.: 3A, 3B W.D.: 3A, 3B M.M.: 3A, 3B M.S.O.: 3A, 3B I.A.M.: 3A, 3B Ethical Compliance Statement: The authors confirm that IRB approval of the institutional review board was not required for this work. Patient consent was obtained and is part of patient's electronic chart. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflicts of Interest: The authors declare no conflicts of interest relevant for this work. No funding was received for this article. Financial Disclosures for the previous 12 months: The authors declare that there are no additional disclosures to report.