PMID- 28659367
OWN - NLM
STAT- MEDLINE
DCOM- 20180409
LR  - 20220410
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2017
DP  - 2017 Jun 28
TI  - Heroin-induced acute myelopathy with extreme high levels of CSF glial fibrillar 
      acidic protein indicating a toxic effect on astrocytes.
LID - bcr-2017-219903 [pii]
LID - 10.1136/bcr-2017-219903 [doi]
LID - bcr2017219903
AB  - 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.
CI  - (c) BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 
      2017. All rights reserved. No commercial use is permitted unless otherwise 
      expressly granted.
FAU - Sveinsson, Olafur
AU  - Sveinsson O
AD  - Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Herrman, Lars
AU  - Herrman L
AD  - Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Hietala, Max Albert
AU  - Hietala MA
AD  - Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170628
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Biomarkers)
RN  - 0 (Glial Fibrillary Acidic Protein)
RN  - 70D95007SX (Heroin)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Astrocytes/*drug effects
MH  - Biomarkers/cerebrospinal fluid
MH  - Drug Users
MH  - Glial Fibrillary Acidic Protein/*cerebrospinal fluid
MH  - Heroin/*toxicity
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Methylprednisolone/therapeutic use
MH  - Paraplegia/cerebrospinal fluid/chemically induced/drug therapy
MH  - Sensation Disorders/cerebrospinal fluid/chemically induced/drug therapy
MH  - Spinal Cord/cytology/*drug effects
MH  - Spinal Cord Diseases/cerebrospinal fluid/*chemically induced/drug therapy
MH  - Substance Abuse, Intravenous
PMC - PMC5534812
OTO - NOTNLM
OT  - Drug misuse (including addiction)
OT  - Immunology
OT  - Neuroimaging
OT  - Neurology (drugs and medicines)
OT  - Spinal cord
COIS- Competing interests: None declared.
EDAT- 2017/07/01 06:00
MHDA- 2018/04/10 06:00
PMCR- 2019/06/28
CRDT- 2017/06/30 06:00
PHST- 2017/06/30 06:00 [entrez]
PHST- 2017/07/01 06:00 [pubmed]
PHST- 2018/04/10 06:00 [medline]
PHST- 2019/06/28 00:00 [pmc-release]
AID - bcr-2017-219903 [pii]
AID - 10.1136/bcr-2017-219903 [doi]
PST - epublish
SO  - BMJ Case Rep. 2017 Jun 28;2017:bcr2017219903. doi: 10.1136/bcr-2017-219903.