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Abstract Details

Mononeuritis multiplex secondary to MDMA
General Neurology
P8 - Poster Session 8 (8:00 AM-9:00 AM)
6-007

NA
3,4-methylenedioxymethamphetamine (MDMA), the psychoactive component of “ecstasy”, is a popular drug of abuse. Amphetamine derivatives, facilitate the release of noradrenaline, serotonin and dopamine by binding monoamine transporters.These neurotransmitters mediate the acute effects of the drug including loss of anxiety, and vibrancy. The systemic effects are minor (trismus, tachycardia) to life threatening (hyperthermia,  acute liver failure, acute kidney injury). The neurotoxic effects are well known and include long term cognitive impairments. To date there are no case reports describing mononeuritis multiplex secondary to MDMA use.

Case: A 16yr old gentleman, was brought to the emergency department following MDMA ingestion. On arrival he had a GCS of 3, temperature of 42C, and was in liver and renal failure. Subsequently, it was noted that the patient had left arm weakness. Examination revealed weakness of shoulder abduction, elbow flexion and wrist extension, with the weakness being more pronounced proximally. The patient was treated with IVIG and made a near complete recovery.

MRI brain showed signal changes in basal ganglia, cortex indicating  hepatic encephalopathy (this resolved on interval imaging). MRI brachial plexus was normal. CSF showed elevated protein.

Nerve conduction studies:  

-Motor slowing with motor conduction block in forearm segment of the left median nerve with motor & sensory axonal loss.

-Sensory axonal loss in the left ulnar nerve.

-Sensory axonal loss in the left lateral antebrachial cutaneous nerve.

-Sensory axonal loss in the radial nerves bilaterally. 

-There was no generalised large fibre neuropathy.

Our patient did not fit the criteria for a critical illness polyneuropathy. To date there have been no case reports of mononeuritis multiplex secondary to MDMA use. We report the first case of a young gentleman who had a significant disability and recovered following a single course of IVIG treatment. The mechanism behind MDMA induced mononeuritis multiplex remains unclear.
Authors/Disclosures
Shameer Rafee, MBBS
PRESENTER 		Dr. Rafee has nothing to disclose.
Sarah Wrigley, MD Dr. Wrigley has nothing to disclose.
Sean Connolly, MD, MRCPI (St. Vincent's University Hospital) Dr. Connolly has received publishing royalties from a publication relating to health care.
Niall Tubridy, MD (St Vincent's University Hospital) Dr. Tubridy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis .