Table 4

 Neurological syndromes associated with drug abuse

Peripheral nervesFemoral/median neuropathyDirect trauma from needle
Mononeuropathies and multiple mononeuropathiesCompressive neuropathies arising from prolonged coma, especially lateral popliteal and ulnar nerves, but also the sciatic nerves
Botulism“Skin-popping” (deep intradermal injections) addicts using “black tar” heroin
Guillain BarréConsider HIV and n-hexane abuse
Plexopathy?Compressive, ?ischaemic
Spinal cordCompressionOsteomyelitis/discitis and extradural abscess
Anterior cord syndromeCord infarction (infective endocarditis, vasospasm, vasculitis)
Intrinsic cord lesionHaemorrhage (infective endocarditis, arteriovenous malformation, vasculitis), abscess
BrainEncephalopathyDirect effect of drug (especially heroin or barbiturate), or
Post-anoxic (secondary to respiratory depression, cardiac arrhythmia or airway obstruction—for example, with aspiration of vomit)
Meningo-encephalitis (must exclude early, do lumbar puncture)
Metabolic: especially sodium or glucose
Head injury
“Vasculitis” (diagnosis of “exclusion” and then biopsy)
MeningitisRemember atypical organisms, and possibility of infective endocarditis, or HIV
Subarachnoid haemorrhageHypertensive surge and co-existent vascular malformation/aneurysm
Myocotic aneurysm with or without infective endocarditis
Stroke: cerebral infarct(s)Vasospasm
Cardiac embolism (infective endocarditis, cardiomyopathy, arrhythmias or paradoxical embolism)
Intracerebral haemorrhageHypertensive surge (especially with underlying AVM)
Septic arteritis and/or mycotic aneurysm
Haemorrhagic transformation of infarct
Subacute focal deficitAbscesses (infective endocarditis or right to left cardiac shunt)
Subdural empyema
Progressive multifocal leucoencephalopathy (PML) if also AIDS
SeizuresDirect effect of drugs (cocaine and amphetamines, and “look alikes”), including hypertensive crisis
Indirectly caused by metabolic complications, including alcohol withdrawal
Abscess or empyema
Stroke (infarction/intracerebral haemorrhage/subarachnoid haemorrhage)
TraumaClosed or from gunshot
Confusion, nystagmus, ataxiaDirectly drug effects (organic solvents and “Angel Dust”)
Posterior fossa abscess/infarct/haemorrhage
External & internal ophthalmoparesis, with fasciobulbar and limb weaknessBotulism from “skin-popping” (subcutaneous injections) heroin addicts, especially “black tar”
Tetanus“Skin-popping” (deep intradermal injections) heroin addicts