Diagnosis of an unclear neurological syndrome by toxicological investigation

Citation
Sw. Toennes et al., Diagnosis of an unclear neurological syndrome by toxicological investigation, DEUT MED WO, 125(30), 2000, pp. 900-902
Citations number
4
Language
TEDESCO
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Volume
125
Issue
30
Year of publication
2000
Pages
900 - 902
Database
ISI
SICI code
Abstract
History and clinical findings: A 51-year-old man without relevant previous illness developed vomiting and diarrhoea, later also tingling and hypaesthe sias in the limbs, as well as optical hallucinations that had occurred afte r a mid-day meal and drinking red wine. Neurological examination revealed v ariable pupillary reactions with anisocoria that would change from one side to the other. There was no paresis, muscle reflexes were brisk, more so on the right. Babinski reflex was positive on the right, there was an unsusta ined clonus of the right foot and the coordination tests were normal. Dista l symmetrical hypaesthesias and paraesthesias were present in all limbs. An exogenous psychosis with restlessness and optical hallucinations was obser ved. Investigations: Routine blood count revealed leukocytosis. Serum concentrat ions of cGt and GPT were raised. Cerebral computed tomography and cerebrosp inal fluid as well as microbiological tests of the mid-day meal were normal . Diagnosis, treatment and course: As the cause of the symptoms was initially unclear the patient was admitted to hospital and monitored without any spe cific treatment. Within one night all symptoms had disappeared and he was d ischarged the next morning without any complaints. Later the red wine which he had drunk was examined toxicologically and found to contain the >>desig ner drug<< DOB (2,5-dimethoxy-4-bromamphetamine). Conclusion: Accidental poisoning with DOB is probably a rare event which ca n hardly be included in routine differential diagnosis. If an acute cerebra l organic syndrome has been excluded, only toxicological investigation can help in establishing the diagnosis in such cases.