Man vs. man-made marijuana: A case of drug-induced posterior reversible encephalopathy syndrome (PRES) due to K2, a synthetic cannabinoid (SCB)

Parajuli, Priyanka; Regmi, Manjari; Lara-Garcia, Odalys; Limon, Ismael Abu; Deckard, Alan

doi:10.1080/20009666.2020.1781349

Cited by 4 publications

(8 citation statements)

References 27 publications

(40 reference statements)

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“…157 CB1 receptor activation may decrease cerebral blood flow, 159 with ischemia noted in the posterior circulation that can mimic signs of posterior reversible encephalopathy syndrome (PRES) in the postpartum period. 160…”

Section: Original Researchmentioning

confidence: 99%

“…84 Strong CB1 agonism (or synthetic cannabinoid (eg, 'K2'/'spice') may lead to or be associated with preeclampsia use may cause or be associated with symptoms resembling preeclampsia, cerebral ischemia, or PRES. 160 Long-term cannabinoid exposure may cause a cross tolerance to opioids and require greater use of opioids. 124 176 Acute intoxication with cannabinoids may augment the analgesia of mu and kappa opioid agonists, thus potentially reducing the dosage requirement for opioids.…”

Section: Intrapartum Anesthetic Considerationsmentioning

confidence: 99%

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ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah

Schwenk

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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BackgroundThe past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.MethodsIn November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.ResultsNine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.ConclusionsSpecific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

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Section: Original Researchmentioning

confidence: 99%

Section: Intrapartum Anesthetic Considerationsmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah

Schwenk

Sondekoppam

et al. 2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…There is no direct connection between the serum levels of immunosuppressive medication and the development of PRES [ 14 ]. Few cases of PRES are be related to consumption of alcohol [ 15 ], cocaine [ 16 ], mephedrone [ 17 ], kratom [ 18 ], and K2 [ 3 ] have been reported in the literature. We report the second case of PRES caused by consumption of K2.…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, among a cohort of college students, it was found that the weighted lifetime prevalence of K2 use at college entry was 7.6% [ 2 ]. Synthetic cannabinoids (SCBs) are increasingly gaining popularity as they are cheaper and are not detected by most standard drug screens [ 3 ]; therefore, its use is more common among low income individuals and high school and college students. K2 can be smoked using joints, pipes, and E-Cigarettes, or it can be brewed as a tea.…”

Section: Introductionmentioning

confidence: 99%

A Case of Synthetic Cannabinoid (K2)-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

et al. 2022

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Patient: Female, 24-year-old Final Diagnosis: K2 induced posterior reversible encephalopathy syndrome Symptoms: Abnormal behavior • headache Medication: — Clinical Procedure: — Specialty: General and Internal Medicine • Toxicology Objective: Unusual clinical course Background: K2 is an artificially synthesized cannabinoid (SCB), manufactured as a non-consumption herbal incense but increasingly misused as a recreational drug. Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by brain edema, often in the setting of acute hypertension. Cases of PRES caused by recreational drug use have been reported in the literature. Case Report: We report an unusual case of PRES after consumption of K2 in a 24-year-old healthy woman who presented with episodic agitation and altered mental status. Magnetic resonance imaging showed nonspecific subtle high T2/FLAIR (fluid-attenuated inversion recovery) signal intensities in the region of the posterior parietal and occipital cortices. Her extensive drug screen report was positive for K2. Her mental status improved over the course of 3 weeks and she had returned to her baseline at 3-month follow-up. Conclusions: Our case highlights the importance of having a high clinical suspicion in patients presenting with altered mental status and a history of recreational drug use. K2 is not detected by routine urine drug testing, so a high level of clinical suspicion is required to request an extensive drug screen. It is important for the physician to counsel active synthetic cannabinoid users regarding these rare complications.

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“…A few case reports show that SCRA users can develop autoimmune disease ( 22 , 23 ). The study by Parajuli et al represents a case about a drug-induced posterior reversible encephalopathy syndrome (PRES) after K2 consumption (a type of SCRAs); besides, the autoimmune mechanism of a toxic origin can be found in the background of PRES ( 24 ). Furthermore, in our previous study, we reported the case of a teenager who used SCRA and was diagnosed with NMDA encephalitis ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Anti-Neuronal Autoantibodies (Cell Surface and Onconeural) and Their Association With Natural Autoantibodies in Synthetic Cannabinoid-Induced Psychosis

et al. 2022

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Patients suffering from encephalitis may present psychiatric symptoms; however, the clinical relevance of anti-neuronal antibodies in patients experiencing a psychotic episode without encephalitis is still unclear. In this study, we examined the presence of anti-neuronal cell surface autoantibodies and onconeural autoantibodies in serum samples of 22 synthetic cannabinoid users presenting with psychosis. We found only two positive cases; however, seven patients had borderline results. Nonetheless, we found no significant correlation between anti-neuronal autoantibodies and the intensity of psychosis indicated by the Positive and Negative Syndrome Scale (PANSS) scores. The length of drug use and the combination of other drugs with synthetic cannabinoids have no significant effect on anti-neuronal autoantibody positivity. Nonetheless, the ratio of anti-citrate synthase (anti-CS) IgM and IgG natural autoantibodies was significantly lower (p = 0.036) in the anti-neuronal autoantibody-positive/borderline samples, than in the negative group. Interestingly, anti-CS IgM/IgG showed a significant negative correlation with PANSS-positive score (p = 0.04, r = −0.464). Our results demonstrated that anti-neuronal autoantibody positivity occurs in synthetic cannabinoid users, and the alteration of anti-CS IgM/IgG natural autoantibody levels points to immunological dysfunctions in these cases.

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Man vs. man-made marijuana: A case of drug-induced posterior reversible encephalopathy syndrome (PRES) due to K2, a synthetic cannabinoid (SCB)

Cited by 4 publications

References 27 publications

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

A Case of Synthetic Cannabinoid (K2)-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

Anti-Neuronal Autoantibodies (Cell Surface and Onconeural) and Their Association With Natural Autoantibodies in Synthetic Cannabinoid-Induced Psychosis

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