Methadone and "Bath Salt" Use Causing Near-Fatal Posterior Reversible Encephalopathy Syndrome (P06.259)

Abstract

Objective: To report previously unreported etiologies of PRES including methadone and bath salt use, resulting in near fatal complications. Background Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized by headache, variable mental status, seizure, visual disturbances, and typical transient changes in the posterior cerebral perfusion. Its pathophysiology remains controversial, however it may be secondary to toxin induce endothelial dysfunction or relative hypertension causing imbalanced Starlin9s forces. The advent of modern brain imaging has afforded an improved understanding with well defined etiologies and presentations, but many atypical presentations exist. While typically associated with a benign prognosis, we present two patients with near fatal PRES related to the street drugs bath salt and methadone. Design/Methods: Case report from a tertiary medical center. Results: Patient 1: 26 year old male presented with acute altered mental status secondary to methadone overdose. Six days after admission patient noted to have new onset seizure, worsening mental status and imaging consistent with PRES. He was treated with anti-epileptics and supportive care. Two days later patient developed signs of brain stem herniation and further imaging revealed uncal and tonsillar herniation with Duvet9s haemorrhages. Patient 2: 51 year old male presented comatose after use of “Bath Salts” a legal drug of abuse with mixed hallucinogenic, agitative and sympathomimetic properties. Imaging confirmed PRES and course was complicated by hydrocephalus requiring extra ventricular drain placement and aggressive ICP management Conclusions: PRES is generally thought to be a benign, transient manifestation of encephalopathy resulting from reversible insult to the blood brain barrier in the setting of toxin, systemic illness, or hypertension with well defined etiologies. However, the cases presented here highlight atypical etiologies, methadone and bath salt use, resulting in near fatal complications. Disclosure: Dr. Pandya has nothing to disclose. Dr. Malaiyandi has nothing to disclose. Dr. Asi has nothing to disclose. Dr. Helms has nothing to disclose. Dr. Lynch has nothing to disclose.