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.
