Acute Neurological Emergencies in Drug Abusers in India

  • Boby Varkey Maramattom


The USA alone spent nearly 25 billion dollars on its federal drug control programme in 2015 with little to show for all its efforts [1]. In spite of this avalanche of money and effort, drug abuse has escalated all over the globe and is spiralling out of control in India. All strata of society are affected, although the economically weaker sections suffer the most due to lack of access to medical help, deaddiction and rehabilitation facilities. In India the largest category of substances that is abused is alcohol [2]. With increasing disposable incomes, the global drug trade is beginning to target India and a wide variety of drugs are now available in India. An acute neurological emergency may be the presenting feature of drug abuse and it is important to keep up to date with these presentations. Unless one has a high index of suspicion, this category of illness will not readily come to mind. As most drugs of abuse have a short half-life, it is important to consider these disorders at the initial presentation and order the appropriate investigations. Although the vast majority of such cases occur in young adult males, there is increased incidence of drug abuse in women and children. As the neurological consequences of alcohol abuse are well known and documented, this review will concentrate on other newer drugs of abuse.


  1. 1.
    White House Office of National Drug Control Policy. National drug control budget: Fy2016 funding highlights. Washington: Office of National Drug Control Policy; 2015.Google Scholar
  2. 2.
    Thara R, Patel V. Role of non-governmental organizations in mental health in India. Indian J Psychiatry. 2010;52(Suppl 1):S389–95.CrossRefGoogle Scholar
  3. 3.
    Ray R, editor. The extent, pattern and trends of drug abuse in India: national survey. New Delhi: United Nations Office on Drugs and Crime-Regional Office for South Asia; 2004.Google Scholar
  4. 4.
    Chakraborty K, Neogi R, Basu D. Club drugs: review of the ‘rave’ with a note of concern for the Indian scenario. Indian J Med Res. 2011;133:594–604.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Herding RI, Better WE, Tate K, et al. Marijuana abusers are at increased risk or stroke: preliminary evidence from cerebrovascular perfusion data. Ann N Y Acad Sci. 2001;939:413–5.CrossRefGoogle Scholar
  6. 6.
    Katsanos AH, Psaltopoulou T, Sergentanis TN, et al. Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: a systematic review and diagnostic test accuracy meta-analysis. Ann Neurol. 2016;79(4):625–35. Scholar
  7. 7.
    Enevoldson TP. Recreational drugs and their neurological consequences. J Neurol Neurosurg Psychiatry. 2004;75:9–15.CrossRefGoogle Scholar
  8. 8.
    Weaver MF, Hopper JA, Gunderson EW. Designer drugs 2015: assessment and management. Addict Sci Clin Pract. 2015;10:8.CrossRefGoogle Scholar
  9. 9.
    Karch SB. Cathinone neurotoxicity (The “3Ms”). Curr Neuropharmacol. 2015 Jan;13(1):21–5.CrossRefGoogle Scholar
  10. 10.
    Merigian KS, Roberts JR. Cocaine intoxication: hyperpyrexia, rhabdomyolysis and acute renal failure. J Toxicol Clin Toxicol. 1987;25(1–2):135–48.CrossRefGoogle Scholar
  11. 11.
    Singhal PC, Rubin RB, Peters A, Santiago A, Neugarten J. Rhabdomyolysis and acute renal failure associated with cocaine abuse. J Toxicol Clin Toxicol. 1990;28(3):321–30.CrossRefGoogle Scholar
  12. 12.
    Stahelin L, Fialho SC, Neves FS, Junckes L, Werner de Castro GR, Pereira IA. Cocaine-induced midline destruction lesions with positive ANCA test mimicking Wegener’s granulomatosis. Rev Bras Reumatol. 2012;52(3):431–7.CrossRefGoogle Scholar
  13. 13.
    Dubil EA, Dahle JM, Owens MD. Bilateral sciatic nerve palsy: a new presentation of toilet bowl neuropathy. J Emerg Med. 2012;43(4):622–4.CrossRefGoogle Scholar
  14. 14.
    Kass-Hout T, Kass-Hout O, Darkhabani MZ, Mokin M, Mehta B, Radovic V. Chasing the dragon—heroin-associated spongiform leukoencephalopathy. J Med Toxicol. 2011;7(3):240–2.CrossRefGoogle Scholar
  15. 15.
    Nebhinani N, Sarkar S, Gupta S, Mattoo SK, Basu D. Demographic and clinical profile of substance abusing women seeking treatment at a de-addiction center in North India. Ind Psychiatry J. 2013;22(1):12–6.CrossRefGoogle Scholar
  16. 16.
    Weiner AL, Vieira L, McKay CA, Bayer MJ. Ketamine abusers presenting to the emergency department: a case series. J Emerg Med. 2000;18(4):447–51.CrossRefGoogle Scholar
  17. 17.
    Barker JC, Karsoho H. Hazardous use of gamma hydroxybutyrate: driving under the influence. Subst Use Misuse. 2008;43:1507–20.CrossRefGoogle Scholar
  18. 18.
    Avella J, Wilson JC, Lehrer M. Fatal cardiac arrhythmia after repeated exposure to 1,1-difluoroethane (DFE). Am J Forensic Med Pathol. 2006;27:58–60.CrossRefGoogle Scholar
  19. 19.
    Jain R, Verma A. Laboratory approach for diagnosis of toluene-based inhalant abuse in a clinical setting. J Pharm Bioallied Sci. 2016;8(1):18–22.CrossRefGoogle Scholar
  20. 20.
    Geibprasert S, Gallucci M, Krings T. Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol. 2010;31(5):803–8.CrossRefGoogle Scholar

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© The Author(s) 2019

Authors and Affiliations

  • Boby Varkey Maramattom
    • 1
  1. 1.Aster Medcity HospitalKochiIndia

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