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Medial Medullary Syndrome in a Drug Abuser

Medial Medullary Syndrome in a Drug Abuser Abstract • A 28-year-old woman with a long history of drug abuse experienced flaccid quadriplegia and bilateral loss of posterior column sensation a few minutes after an intravenous (IV) injection of methylphenidate hydrochloride. Subsequently, spasticity developed and she showed minimal functional improvement during a period of several months. Necropsy performed 81/2 months later showed systemic granulomatosis due to talc and two ischemic infarctions, one involving both medial medullary areas and the other involving the left frontal lobe. Deposits of talc, presumably from a medication prepared for oral use, were demonstrated in the small vessels in the area of the medullary infarction. This case is unique in that the medial medullary syndrome was apparently caused by an embolus of talc following its IV administration. References 1. Atlee WE, Jr: Talc and corn starch emboli in eyes of drug abusers . JAMA 219:49-51, 1972.Crossref 2. Growth DH, Mackag GR, Gable JV, et al: Intravenous injection of talc in a narcotic addict . Arch Pathol 94:171-178, 1972. 3. Davison C: Syndrome of the anterior spinal artery of the medulla oblongata . Arch Neurol Psychiat 37:91-107, 1937.Crossref 4. Davison C: Syndrome of the anterior spinal artery of the medulla oblongata . J Neuropathol Exp Neurol 3:73-80, 1944.Crossref 5. Thelles JO, Thelles L, Urquiaga C: La ramollissement médian du dulbe—A propos de deux cas anatomo-cliniques . Rev Neurol 129:91-104, 1973. 6. Hiller F: The vascular syndromes of the basilar and vertebral arteries and their branches . J Nerv Ment Dis 116:988-1016, 1952.Crossref 7. Currier RD: Syndromes of the medullar oblongata , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . Amsterdam, North Holland Publishing Corp, 1969, vol 2, pp 213-237. 8. Hauw JJ, Der Angopian P, Thelles L, et al: Les infarctus bulbaires—Etude systématique de la topographie lésionelle dans 49 cas . J Neurol Sci 28:83-102, 1976.Crossref 9. Escourolle R, Hauw JJ, Der Angopian P, et al: Les infarctus bulbaires—Etude des lésion vascularies dans 26 observations . J Neurol Sci 28:103-113, 1976.Crossref 10. O'Brien FB, Bender MB: Localizing value of vertical nystagmus . Arch Neurol Psychiatry 54:378-380, 1945.Crossref 11. Fisher DM, Curry HB: Pure motor hemiplegia of vascular origin . Arch Neurol 13:30-44, 1965.Crossref 12. Ropper AH, Fisher CM, Kleinman GM: Pyramidal infarction in the medulla: A cause of pure motor hemiplegia sparing the face . Neurology 29:91-95, 1979.Crossref 13. Hopkins GB: Pulmonary angiothrombotic granulomatosis in drug offenders . JAMA 221:909, 1972.Crossref 14. Talc granulomata in liver disease in narcotic addicts . Arch Pathol 98:331-335, 1974. 15. Plum F, Posner JB: Diagnosis of Stupor and Coma . Philadelphia, FA Davis Co, 1973, pp 24-25, 126-127. 16. Kemper TL, Romanul FCA: State resembling akinetic mutism in basilar artery occlusion . Neurology 17:74-80, 1967.Crossref 17. Meyer JS, Herndon RM: Bilateral infarction of the pyramidal tracts in man . Neurology 12:637-642, 1962.Crossref 18. Spiller WG: The symptom complex of a lesion of the uppermost portion of the anterior spinal and adjoining portion of the vertebral arteries . J Nerv Ment Dis 35:775-778, 1908.Crossref 19. Brown WJ, Fang HCH: Spastic hemiplegia in man . Neurology 2:829-835, 1961.Crossref 20. Trelles JO, Trelles L, Urquiaga CL: La spasticité dans l'hémiplégie par lésion de la pyramide bulbaire . Rev Neurol 129:105-112, 1973. 21. Hahn HH, Schweid A, Beatty HW: Complications of injecting dissolved methylphenidate tablets . Arch Intern Med 123:656-659, 1969.Crossref 22. Siegel H: Human pulmonary pathology associated with narcotic and other addictive drugs . Hum Pathol 3:55-66, 1972.Crossref 23. Puro HE, Wolf PL, Skirgaudas J, et al: Experimental production of "human blue velvet and red devil" lesions . JAMA 197:1100-1102, 1966.Crossref 24. Ritland D, Butterfield W: Extremity complications of drug abuse . Am J Surg 126:639-648, 1973.Crossref 25. Edland JF: Liver disease in heroin addicts . Hum Pathol 3:75-84, 1972.Crossref 26. Richter RW, Pearson J, Braun B, et al: Neurological complications of addiction to heroin . Bull NY Acad Med 49:3-21, 1973. 27. Solitare GB: Neurologic aspects of drug dependency (narcotic addiction) . Hum Pathol 2:85-89, 1972.Crossref 28. Pearson J, Richter RW, Baden MM, et al: Transverse myelopathy as an illustration of the neurologic and neuropathologic features of heroin addiction . Hum Pathol 3:107-113, 1972.Crossref 29. Hall JJ III, Carp HR: Acute progressive ventral pontine disease in heroin abuse . Neurology 23:6-7, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Medial Medullary Syndrome in a Drug Abuser

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Publisher
American Medical Association
Copyright
Copyright © 1980 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1980.00500560055006
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Abstract

Abstract • A 28-year-old woman with a long history of drug abuse experienced flaccid quadriplegia and bilateral loss of posterior column sensation a few minutes after an intravenous (IV) injection of methylphenidate hydrochloride. Subsequently, spasticity developed and she showed minimal functional improvement during a period of several months. Necropsy performed 81/2 months later showed systemic granulomatosis due to talc and two ischemic infarctions, one involving both medial medullary areas and the other involving the left frontal lobe. Deposits of talc, presumably from a medication prepared for oral use, were demonstrated in the small vessels in the area of the medullary infarction. This case is unique in that the medial medullary syndrome was apparently caused by an embolus of talc following its IV administration. References 1. Atlee WE, Jr: Talc and corn starch emboli in eyes of drug abusers . JAMA 219:49-51, 1972.Crossref 2. Growth DH, Mackag GR, Gable JV, et al: Intravenous injection of talc in a narcotic addict . Arch Pathol 94:171-178, 1972. 3. Davison C: Syndrome of the anterior spinal artery of the medulla oblongata . Arch Neurol Psychiat 37:91-107, 1937.Crossref 4. Davison C: Syndrome of the anterior spinal artery of the medulla oblongata . J Neuropathol Exp Neurol 3:73-80, 1944.Crossref 5. Thelles JO, Thelles L, Urquiaga C: La ramollissement médian du dulbe—A propos de deux cas anatomo-cliniques . Rev Neurol 129:91-104, 1973. 6. Hiller F: The vascular syndromes of the basilar and vertebral arteries and their branches . J Nerv Ment Dis 116:988-1016, 1952.Crossref 7. Currier RD: Syndromes of the medullar oblongata , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . Amsterdam, North Holland Publishing Corp, 1969, vol 2, pp 213-237. 8. Hauw JJ, Der Angopian P, Thelles L, et al: Les infarctus bulbaires—Etude systématique de la topographie lésionelle dans 49 cas . J Neurol Sci 28:83-102, 1976.Crossref 9. Escourolle R, Hauw JJ, Der Angopian P, et al: Les infarctus bulbaires—Etude des lésion vascularies dans 26 observations . J Neurol Sci 28:103-113, 1976.Crossref 10. O'Brien FB, Bender MB: Localizing value of vertical nystagmus . Arch Neurol Psychiatry 54:378-380, 1945.Crossref 11. Fisher DM, Curry HB: Pure motor hemiplegia of vascular origin . Arch Neurol 13:30-44, 1965.Crossref 12. Ropper AH, Fisher CM, Kleinman GM: Pyramidal infarction in the medulla: A cause of pure motor hemiplegia sparing the face . Neurology 29:91-95, 1979.Crossref 13. Hopkins GB: Pulmonary angiothrombotic granulomatosis in drug offenders . JAMA 221:909, 1972.Crossref 14. Talc granulomata in liver disease in narcotic addicts . Arch Pathol 98:331-335, 1974. 15. Plum F, Posner JB: Diagnosis of Stupor and Coma . Philadelphia, FA Davis Co, 1973, pp 24-25, 126-127. 16. Kemper TL, Romanul FCA: State resembling akinetic mutism in basilar artery occlusion . Neurology 17:74-80, 1967.Crossref 17. Meyer JS, Herndon RM: Bilateral infarction of the pyramidal tracts in man . Neurology 12:637-642, 1962.Crossref 18. Spiller WG: The symptom complex of a lesion of the uppermost portion of the anterior spinal and adjoining portion of the vertebral arteries . J Nerv Ment Dis 35:775-778, 1908.Crossref 19. Brown WJ, Fang HCH: Spastic hemiplegia in man . Neurology 2:829-835, 1961.Crossref 20. Trelles JO, Trelles L, Urquiaga CL: La spasticité dans l'hémiplégie par lésion de la pyramide bulbaire . Rev Neurol 129:105-112, 1973. 21. Hahn HH, Schweid A, Beatty HW: Complications of injecting dissolved methylphenidate tablets . Arch Intern Med 123:656-659, 1969.Crossref 22. Siegel H: Human pulmonary pathology associated with narcotic and other addictive drugs . Hum Pathol 3:55-66, 1972.Crossref 23. Puro HE, Wolf PL, Skirgaudas J, et al: Experimental production of "human blue velvet and red devil" lesions . JAMA 197:1100-1102, 1966.Crossref 24. Ritland D, Butterfield W: Extremity complications of drug abuse . Am J Surg 126:639-648, 1973.Crossref 25. Edland JF: Liver disease in heroin addicts . Hum Pathol 3:75-84, 1972.Crossref 26. Richter RW, Pearson J, Braun B, et al: Neurological complications of addiction to heroin . Bull NY Acad Med 49:3-21, 1973. 27. Solitare GB: Neurologic aspects of drug dependency (narcotic addiction) . Hum Pathol 2:85-89, 1972.Crossref 28. Pearson J, Richter RW, Baden MM, et al: Transverse myelopathy as an illustration of the neurologic and neuropathologic features of heroin addiction . Hum Pathol 3:107-113, 1972.Crossref 29. Hall JJ III, Carp HR: Acute progressive ventral pontine disease in heroin abuse . Neurology 23:6-7, 1973.Crossref

Journal

Archives of Neurology – American Medical Association

Published: Jul 1, 1980

References

  • Talc and corn starch emboli in eyes of drug abusers
    Atlee WE, Jr
  • Intravenous injection of talc in a narcotic addict
    Growth DH, Mackag GR, Gable JV, et al
  • Syndrome of the anterior spinal artery of the medulla oblongata
    Davison C
  • Syndrome of the anterior spinal artery of the medulla oblongata
    Davison C
  • La ramollissement médian du dulbe—A propos de deux cas anatomo-cliniques
    Thelles JO, Thelles L, Urquiaga C
  • The vascular syndromes of the basilar and vertebral arteries and their branches
    Hiller F
  • Handbook of Clinical Neurology
    Currier RD
  • Les infarctus bulbaires—Etude systématique de la topographie lésionelle dans 49 cas
    Hauw JJ, Der Angopian P, Thelles L, et al
  • Les infarctus bulbaires—Etude des lésion vascularies dans 26 observations
    Escourolle R, Hauw JJ, Der Angopian P, et al
  • Localizing value of vertical nystagmus
    O'Brien FB, Bender MB
  • Pure motor hemiplegia of vascular origin
    Fisher DM, Curry HB
  • Pyramidal infarction in the medulla: A cause of pure motor hemiplegia sparing the face
    Ropper AH, Fisher CM, Kleinman GM
  • Pulmonary angiothrombotic granulomatosis in drug offenders
    Hopkins GB
  • Talc granulomata in liver disease in narcotic addicts
  • Diagnosis of Stupor and Coma
    Plum F, Posner JB
  • State resembling akinetic mutism in basilar artery occlusion
    Kemper TL, Romanul FCA
  • Bilateral infarction of the pyramidal tracts in man
    Meyer JS, Herndon RM
  • The symptom complex of a lesion of the uppermost portion of the anterior spinal and adjoining portion of the vertebral arteries
    Spiller WG
  • Spastic hemiplegia in man
    Brown WJ, Fang HCH
  • La spasticité dans l'hémiplégie par lésion de la pyramide bulbaire
    Trelles JO, Trelles L, Urquiaga CL
  • Complications of injecting dissolved methylphenidate tablets
    Hahn HH, Schweid A, Beatty HW
  • Human pulmonary pathology associated with narcotic and other addictive drugs
    Siegel H
  • Experimental production of "human blue velvet and red devil" lesions
    Puro HE, Wolf PL, Skirgaudas J, et al
  • Extremity complications of drug abuse
    Ritland D, Butterfield W
  • Liver disease in heroin addicts
    Edland JF
  • Neurological complications of addiction to heroin
    Richter RW, Pearson J, Braun B, et al
  • Neurologic aspects of drug dependency (narcotic addiction)
    Solitare GB
  • Transverse myelopathy as an illustration of the neurologic and neuropathologic features of heroin addiction
    Pearson J, Richter RW, Baden MM, et al
  • Acute progressive ventral pontine disease in heroin abuse
    Hall JJ III, Carp HR