A patient using a synthetic cannabinoid may develop acute disseminated encephalomyelitis (ADEM).
Onset: usually 4 to 13 days after triggering event
The clinical course may be monophasic, recurrent, or multiphasic.
General symptoms may include:
(1) fever
(2) vomiting
(3) weakness
(4) headache
Neurological findings:
(1) change in behavior, including agitation
(2) altered consciousness (lethargy, stupor, or coma)
(3) ataxia
(4) hemiparesis
(5) dystonia
(6) choreiform movements
(7) aphasia
(8) diplopia
(9) dyslexia
(10) cranial nerve palsy
(11) flaccid paralysis
(12) urinary retention and/or constipation and/or incontinence
Brain CT shows multifocal asymmetric areas that are irregular and poorly marginated mainly in cortical gray-white junction, best seen in T2-weighted and fluid-attenuated inversion recovery images.
The diagnosis of cannabinoid-related requires exclusion of alternative explanations such as infection, vaccination or autoimmune disorder. Brandehoff et al found additives in some patients that included cocaine, NRG-3, MeO-PCP, and methamphetamine. In addition, contaminants related to the drug synthesis may be present.
