Abstract Details

Title Reversible Neuroimaging findings associated with Kratom use.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-021

Objective To report a case of reversible ischemic changes on MRI associated with chronic kratom use in a patient presenting with encephalopathy and seizures

Background Mitragyna speciosa, or kratom, is a psychoactive substance that targets multiple opioid receptors and has been an unregulated and under-reported substance of abuse. Its use has been reported to cause liver toxicity, respiratory depression, neuropsychiatric issues and even death. Its neurological side effects at this time are not well established.

Design/Methods We report a case of a 23-year-old male with a medical history significant for polysubstance abuse who presented for acute encephalopathy and seizure-like episode, requiring ICU admission and intubation for airway protection.

Results Patient initially presented with hypotension , leukocytosis, and lactic acidosis concerning sepsis. He was started on broad spectrum antibiotics for meningitis coverage and Keppra to prevent further seizures. Urine toxicology screen was negative. Once examined off sedation, the patient was noted to have right upper extremity weakness with babinski reflex on right concerning stroke therefore an MRI was obtained. It revealed small areas of confluent juxtacortical white matter abnormality high in the posterior frontal lobes bilaterally with some true diffusion restriction on the left suggestive of acute infarct. However, the appearance was unusual for a stroke. Further history from the family revealed that the patient uses Kratom on a daily basis for a number of years to help with anxiety. He had no further seizures and his mental status improved during the remainder of his hospitalization. Repeat MRI Brain 2 months after initial presentation showed resolution of the abnormalities.

Conclusions Kratom has been reported in the past to cause neurological issues like seizures or PRES. This case shows reversible ischemic neuroimaging findings of Kratom use in a patient with a stroke-like presentation.

Authors/Disclosures
Sindhu Reddy Pisati, MD, MBBS (Southern Illinois University) PRESENTER	Dr. Pisati has nothing to disclose.
Syed Y. Shah, MD	Dr. Shah has nothing to disclose.
Andrew Thaliath, MBBS	Dr. Thaliath has nothing to disclose.
Shashi K. Maryala, MBBS (Southern Illinois University Neuroscience Institute)	Dr. Maryala has nothing to disclose.
Hesham A. Allam, MD (Saint Louis University Hospital)	Dr. Allam has nothing to disclose.

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