16JOURNAL OF MEDICAL TOXICOLOGYCerebrovascular accident CVA is the t - PDF document

16JOURNAL OF MEDICAL TOXICOLOGYCerebrovascular accident (CVA) is the third leading cause ofA) is the third leading cause of…accident in relation to 3,4-methylenedioxymethamphetamine(MDMA, ecstasy) is rare and not much is known about thepathophysiology [3…4].The Drug Abuse Warning Network (DAWN) is a surveillanceveillance…DAWN System reported that ED visits for MDMA rose from 253visits secondary to MDMA use included multiple drug intoxica-25 [5]. Updated reports from DAWN showed that ED visits forWN showed that ED visits for…The National Institute on Drug Abuses Community Epidemi-ology Workgroup (CEWG) recently reported that the use of2003 reports from Texas, Illinois and New York, it appears thatork, it appears thatCASE REPORTA 20-year-old African American male, behaving strangely, arrivedat the ED. The patients brother witnessed the patient drinkingbeer, smoking marijuana (THC) and ingesting MDMA prior toand became aphasic. An hour later, he was taken to the ED.Toxicology Observationsincluded blood pressure: 142/57, pulse: 98, respiratory rate: 20,pulse oximetry: 98% on room air and a temperature of: 37.1.in the upper and lower extremities but otherwise dif“cult to ex-4mm, equal, round and bilaterally reactive. Extra ocular move-ments were intact via tracking. Oropharnyx was clear, and hisnon-distended, non-tender, a

nd bowel sounds were present. His2 bilaterally.Laboratory values showed a glucose level of 126mg/dl. Hisbands. Serum chemistry panel, urinalysis, and sedimentationels were undetectable. The CPK level was 692 units/liter. Hisethanol level was 113mg/dl. A urine drug screen was negativeing pressure was 140mm Hmicroliter, a RBC of 42 per microliter, a glucose of 67mg/dl anda total protein of 47mg/dl.artery complete infarction (Figure) , V. Tuckler, MDCorresponding Author: carotid artery. His sickle cell, anti-nuclear antibody, homocys-con“rmed etiology for the CVA.driasis, agitation, bruxism, dry mouth and seizures [1]. Fatal com-y mouth and seizures [1]. Fatal com-…of CVA from MDMA but suggest vasospasm as a mechanism [1].into synapses that produces euphoric sensations. However, in re-vasoconstriction and an increased risk for stroke [2]. Similarly, ainfarction. An angiogram showed left middle cerebral arteryMDMA and CVA [3]. An article from the United States discussesondary to vasoconstriction [11].ever, the patients brother reportedly witnessed the MDMAUnfortunately, data from the DAWN reports have repeatedlyMARCH 200617Figure 1. MRI of the patients brain with complete left middle cerebral artery infarction. MDMA and include CVA in the differential diagnosis with any 1.Scott PA, Barsan WG. Stroke, Transient Ischemic Attack,and other

Central Focal Conditions. In: Tintinalli JE, Kelen, GD,ed.). New York: McGraw-Hill Companies, Inc;2.National Center for Health Statistics. Health. UnitedStates. 2001. Hyattsville, Md. Public Health Service. Available from: http://www.cdc.gov/nchs/3.Reneman L, Habraken JBA, Majoie CBL, Booij J, denaccidents: preliminary “ndings. Am J Neuroradiol. 4.Manchanda S. Connolly MJ. Cerebral infarction in asso-ciation with Ecstasy abuse. Postgrad Med Jour. 5.The DAWN Report. Club Drugs. Of“ce of Applied Studies,Substance Abuse and Mental Health Services Administration.; Available from: http://dawninfo.samhsa.gov/6.The DAWN Report. Club Drugs, 2001 Update. Of“ce ofApplied Studies, Substance Abuse and Mental Health Services. Available from: http://dawninfoDAWN_tdr_club_drugs02.pdf7.Gauvin, DV. Recent drug use trends in the U.S: TheatAAEM National Scienti“c Meeting, February 22, NewOrleans, LA.8.The National Institute on Drug Abuse. Research ReportSeries„MDMA Abuse (Ecstasy). February ; Available from:http://www.drugabuse.gov/ResearchReports/MDMA/MDMA39.Dowling GP, McDonough ET, Bost, RO. Eve and ecstasy:Areport of “ve deaths associated with the use of MDEA and10.Henry JA, Jefferys KJ, Dawlings S. Toxicity and deaths11.Singhal AB, Caviness VS, Begleiter AF, Mark EJ, Rordorf G,serotonergic drugs. Neurology. 18JOURNAL OF MEDICAL TOXICOLOGY