Sveinsson Olafur, Herrman Lars, Hietala Max Albert
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
BMJ Case Rep. 2017 Jun 28;2017:bcr-2017-219903. doi: 10.1136/bcr-2017-219903.
A man aged 33 years with previous heroin substance abuse was found unconscious lying in a bush. The patient had been without heroin for some time but had just started to use intravenous heroin again, 0.5-2 g daily. The patient had almost complete paraplegia and a sensory loss for all modalities below the mamillary level and a urine retention of 1.5 L. Acute MRI of the spine revealed an expanded spinal cord with increased intramedullary signal intensity, extending from C7-T9. The cerebrospinal fluid showed extremely high levels of nerve injury markers particularly glial fibrillar acidic protein (GFAP): 2 610 000/ng/L (ref. <750). The patient was empirically treated with intravenous 1 g methylprednisolone daily for 5 days and improved markedly. Very few diseases are known to produce such high levels of GFAP, indicating a toxic effect on astrocytes. Measuring GFAP could possibly aid in the diagnosis of heroin-induced myelopathy.
一名33岁有海洛因药物滥用史的男子被发现昏迷在灌木丛中。该患者已有一段时间未接触海洛因，但刚刚又开始每天静脉注射0.5 - 2克海洛因。患者几乎完全截瘫，乳头水平以下所有感觉丧失，并有1.5升尿潴留。脊柱急性磁共振成像（MRI）显示脊髓增粗，髓内信号强度增加，范围从C7至T9。脑脊液显示神经损伤标志物尤其是胶质纤维酸性蛋白（GFAP）水平极高：2610000/ng/L（参考值<750）。该患者经验性地接受了每天静脉注射1克甲泼尼龙，共5天，病情明显改善。已知很少有疾病会产生如此高的GFAP水平，这表明对星形胶质细胞有中毒作用。检测GFAP可能有助于海洛因诱导的脊髓病的诊断。
