Samra Kiran, Boon Ian S, Packer Gregory, Jacob Saiju
Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
BMJ Case Rep. 2017 Apr 22;2017:bcr-2016-218431. doi: 10.1136/bcr-2016-218431.
A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid () 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid , technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.
一名此前身体健康的25岁男性出现了躁动、大小便失禁和左侧运动不协调的症状。他的症状在5天前吸食一种合成大麻素后开始出现。在48小时内，他发展为失语、全身肌张力增高、反射亢进和严重的左侧偏瘫。病情进一步发展为大量出汗、发热、心动过速、高血压，还可能发生了癫痫，因此需要入住重症监护病房。头部CT和脑脊液分析均无异常。脑部MRI显示白质和灰质有不对称的多灶性高信号病变，这引发了对急性播散性脑脊髓炎（ADEM）的怀疑。脑电图显示广泛的脑电波减慢，提示弥漫性脑功能障碍。脑血管造影正常。对该物质的毒理学分析证实是一种强效合成大麻素，当时在技术上是合法的。经过静脉注射甲基强的松龙、静脉注射免疫球蛋白和口服类固醇治疗后，患者恢复缓慢但有明显改善，后来被转到康复病房。
