1. Neurological Complications of Heroin Case Study Department of Neurology Alfred Hospital 26 April, 2000.

2. Presentation P. G. 17 year old boy sudden onset quadraparesis, beginning at the C7/8 myotome, Decreased pinprick/pain/temperature sensation over right limbs and right side of torso Background of regular IV heroin use.

3. Past History: IVDU Hep C Social History: Under Department of Human services Mother lives in Darwin Limited contact with father

4. History of presenting complaint 25/2/00: Hit of heroin whilst at home at 22:00. Lay on the couch with head hyperextended over the armrest of the couch. Awoke several hours later unable to move. Crawled around room, then fell asleep on the floor. 26/2/00: Awoke early, still unable to move Ambulance called  The Alfred On arrival: Unable to move both hands/legs Acute urinary retention 1.5L

5. Examination findings Part I Cranial nerves intact Peripheral neurological examination: Upper: Decreased power 2/5 from the level of C7 myotome Decreased pin prick and pain sensation beginning C7 dermatome on the right ( C6, 7 on the left solely) Normal biceps reflex, decreased supinator & triceps jerk bilaterally Lower: Flaccid on presentation Paraparesis 2+/5 all muscle groups Knee jerks: initially decreased Plantars up going bilaterally

6. Examination findings Part II Cardiovascular examination: No murmurs No evidence of endocarditis Residual volume: 1,100mls  catheterised

7. Progress Part I Investigated to exclude differential diagnostic considerations: Demyelination Vasculitis Cardioembolic phenomenon Heroin induced myelopathy Evolving spasticity in lower limbs Ambulating without assistance Catheter removed : residual volume of 140 mls

8. Progress Part II Planned transfer to Royal Talbot for continued rehabilitation: Patient discharged himself against medical advice Outpatient physiotherapy &ongoing drug counselling arranged through Royal Talbot in May. Follow up meeting with DHS 1/52 following discharge  patient using heroin again

9. Investigations U&E: 137/4/4.5/0.07 FBE: 157/9.92/308 Vasculitic screen (ENA,ANA, ANCA, Lupus inhibitor screen, cryoglobulin, ACE –ve) Demyelination: serum electrophoresis NAD CSF: Clear and colourless, glucose 2.8 (serum 4), protein 0.74, negative oligoclonal bands HIV: -ve TOE: NAD CK: 7000 peak

10. Thank You