Medical Journal of The Islamic Republic of Iran (MJIRI)

  Abstract

  The usage of heroin is associated with a variety of neurologic disorders, including

  acute transverse myelitis. In this study we present a 19 year old man who was suffered

  from insufflated heroin after several months of abstinence, and admitted to hospital

  emergency department, unconscious. He responded to fluid therapy and Naloxone,

  but could not move his legs on examination. He had flaccid paralysis of both

  legs, acute urinary retention and diminished rectal tone. Deep tendon reflexes were

  absent with downward plantar reflexes. Analysis of CSF was normal, and the MRI of

  the spine revealed confluent hyperintensity on T2-weighted images from the C5 to

  T2 vertebral levels involving the majority of the cord substance. The cord was mildly

  expanded without any enhancement after Gadolinium injection. Suggested mechanisms

  of heroin-associated myelopathy include hypotension, a direct toxic effect of

  heroin, vasculitis, and hypersensitivity reaction. Hypersensitivity was the predominant

  theory since the initial reports, implied that most patients with developed

  myelopathy had relapsed into heroin use after a period of abstinence. Treatment with

  either IV corticosteroids or immunopheresis could blunt the immune response, preventing disability. Efficacy of these methods require more studies in future.