O39: Death by self-mutilation after cannabis consumption in a patient with cortical dysplasia

Abstract

Aims The use of cannabis has been linked to an increased risk for acute psychosis, especially delirious episodes or schizophrenicspectrum disorders. Self-mutilation and dissociative disorders are rare (Bergua A et al. Ophthalmologica 2002;216:269–71). On the contrary, according to some authors, cannabis resin consumption would reduce these disorders (Passie T et al. Drug Test Anal. 2012;4:649-59). We report on original case of death by automutilation in a patient with cortical dysplasia following consumption of a highly concentrated resin cannabis. Case report Mr. B., 36 years-old, presents on the public roads a major state of agitation with self-mutilation and bilateral enucleation. Despite the intervention of emergency services, he impales on the fence and dies in an array of cataclysmic hemorrhage. According to statements of two witnesses who have spent the day with the victim, he would have presented a state of major agitation after spending few minutes in his apartment. They also indicate that the victim was a regular cannabis user and had presented unlabeled psychiatric disorders few years earlier. Four fragments of a brown substance resembling cannabis resin were seized at the home of the victim. Methods The autopsy was performed 12 hours later. Toxicological samples (cardiac blood, peripheral blood, pleural fluid, gastric content, vitreous humor and hair) were taken. Blood screening for major drugs and narcotics was done by LC-MS/MS. Dosages of amphetamines, opiates and cocaine were done by GC-MS, quantification of cannabinoids by GC-MS/MS. Identification and dosage of hallucinogens, new synthetic drugs, and synthetic cannabinoids were performed by LC-MS and LC-MS/MS. The composition of the four brown fragments seized at the home of the victim was determined by GC-MS and GC-FID. A pathological expertise was also performed. Results Toxicological analysis of the biological fluids and hair revealed the presence of different markers of cannabis consumption: THC 11-OH-THC THC-COOH Cannabinol Cannabidiol Cardiac blood (ng/mL) 25 3.2 13 0.6 0.3 Femoral blood (ng/mL) 13.5 4.1 14.7 1.3 0.7 Gastric content (ng/mL) 868 0.8 26 – 22 Hair (1,5 cm) (pg/mg) 137 1 ns* 9 94 These results indicate a recent cannabis consumption and the high gastric concentrations are in favor of an orally absorption. Hair analysis confirms regular consumption. A postmortem redistribution between the blood compartments can be observed. The analysis of fragments (F1 to F4) confirmed that it was cannabis resin with following composition (%): THC Cannabinol Cannabidiol F1- F3 31.1 5.5 1 F2 34.8 6 1.1 F4 35.4 6 1 The 4 pieces of cannabis resin highlights similar qualitative and quantitative composition with very high levels of active compounds. The pathological expertise reveals brain cortical dysplasia and lung lesions alveolitis type with pigmented macrophages related to regular toxic inhalation. Discussion and conclusion cortical dysplasia induces seizures and hallucinations. In this particular case, the absorption of a large dose of an highly concentrated cannabis extract may have caused hallucinations and dissociative disorders.