Neurological Manifestations Associated with Synthetic Cannabinoid Use- A Case Series

Abstract

Background: Synthetic Cannabinoid (SC) use has emerged as a growing public health threat in the United States. Several unexpected cases, presenting with a constellation of unrelated symptoms, but all having toxicity linked to SC use, have been reported in the last decade (2010-2019). Methods: We report a cluster of several independent cases where patients were admitted having different neurological manifestations. Extensive and expensive work-ups were performed. Upon further inspection, extended toxicology screens were found to be positive for SC metabolites. Results: It is alarming to observe that several reports highlight an increase in the varied and significant morbidity associated after SC use. Various SC compositions have been synthesized and distributed, with new molecules being generated at a staggering rate leading to unexpected manifestations. Conclusion: Young people are the most frequent users owing to its recreational effects, its easy accessibility, lower cost and difficulty in being detected in the urine by routine drug screens. From a hospital quality improvement perspective, efforts to characterize the presence of newly generated SC molecules and establish more accessible in-house screening methods will be a starting step in reducing the associated cost-burden. This will also minimize the unnecessary invasive procedures performed on a specific patient. From a socioeconomic viewpoint, solid and systematic crosstalk with increased recognition and reporting mechanism between the healthcare staff and public health personnel is strongly warranted to support state and federal regulatory efforts in combating this ongoing SC epidemic.

Acute Disseminated Encephalomyelitis Associated With Chronic Cannabis Abuse

“…To the best of our knowledge, there have been no reports of ADEM caused by chronic cannabis abuse, though Samra et al reported ADEM in a healthy 25-year-old man after using a synthetic cannabinoid called Black Mamba [ 9 ]. Other cases of neurological diseases associated with synthetic cannabinoid use have also been reported, though the causative mechanism in those patients was unknown [ 10 ]. However, a growing body of research suggests that chronic cannabinoid exposure, particularly during adolescence, can have neurotoxic effects on developing white matter, resulting in decreased white matter coherence, though the physiopathology is unknown.…”

Case Report: Syphilitic Hepatitis–A Rare and Underrecognized Etiology of Liver Disease With Potential for Misdiagnosis

“…A vasculotropic and epitheliotropic pattern of inflammation may be seen in some cases, but this is not etiologically specific and overlaps with other, more common inflammatory liver diseases. Although identification of spirochetes in the tissue by special stain or immunohistochemistry is diagnostic in the appropriate setting (11), false negative staining is not uncommon in the setting of disseminated treponemal disease, reaffirming the need for close clinicopathologic correlation to make the diagnosis in most cases. In the absence of known or reported risk factors for SH, the diagnosis is likely to be missed.…”

“…Heightened clinical awareness and recognition of patients at risk for the disease are necessary to facilitate timely diagnosis and treatment. Risk factors including unprotected sexual activity, polysubstance abuse and IDU attribute to notably high rates of coinfection, increased hospital costs and a massive burden on the healthcare system ( 2 , 12 , 13 ). The incidence of primary and secondary syphilis are on the rise ( 1 ), and the identification and treatment of syphilis cases prevents progression to tertiary syphilis in affected individuals and the spread to other individuals.…”