Abstract Details

Title Clinical and Radiographic Characterization of Synthetic Cannabinoid-induced Toxic Leukoencephalopathy

Topic General Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-024

Objective To characterize the clinical presentation and radiographic findings of synthetic cannabinoid-induced toxic leukoencephalopathy

Background Synthetic cannabinoids (SCBs) are a class of heterogeneous compounds derived from tetrahydrocanabinoid (THC), and sold over-the-counter in the United States. Despite a wide consumer base, SCBs are a particularly rare cause of toxic leukoencephalopathy, with few cases reported in the literature. Comparatively, there is no reported effect of marijuana consumption on white matter, even at excessive doses. This study seeks to describe the presentation, neurologic deficits, and imaging findings as a means to raise clinical awareness of a likely underreported disorder

Design/Methods A query for patients with diagnosis of toxic leukoencephalopathy was conducted within the patient databases of 2 university hospitals. Inclusionary criteria included at least 18 years of age, urine drug screen (UDS) performed on initial presentation, and diffuse white matter aberration on at least 1 magnetic resonance imaging (MRI) sequence. Exclusionary criteria included carbon monoxide or chemotherapeutic exposure, hypoxic-ischemic event, metabolic derangement, or urine drug screen positive for amphetamines, benzodiazepines, barbiturates, cocaine, opioids or phencyclidine. We review the clinical sequelae and MRI findings of these cases.

Results We report 6 cases of probable SCB-induced toxic leukoencephalopathy across a five-year time span. 5/6 (83.33%) of patients had a reported history of concomitant marijuana use, while only 2/6 (33.33%) bore UDS positive for cannabinoids. 2/6 patients (33.33%) presented with focal neurologic deficits, including 1 instance of clinical parkinsonism. 3/6 (50%) showed diffuse supraventricular or periventricular involvement on diffusion-weighted MRI. 4/6 (66.66%) and 6/6 (100%) showed similar involvement on T1- and T2/FLAIR weighted imaging, respectively.

Conclusions Urine drug screen is an insensitive marker for SCB neurotoxicity, while history of concomitant marijuana may be a common risk factor. T2/FLAIR is the most likely imaging sequence to aid diagnosis.

Authors/Disclosures
Jordan Amar, MD (Washington University/Barnes-Jewish Hospital) PRESENTER	No disclosure on file
Jeffrey Ruta, MD	Dr. Ruta has nothing to disclose.
David Rahimian, MD	No disclosure on file
Paul M. Katz, MD (Temple University Health System)	Dr. Katz has nothing to disclose.

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