Drug-induced Parkinsonism in a Patient with Methamphetamine Abuse (P4.317)

Abstract

OBJECTIVE: To describe a case of drug-induced parkinsonism in a patient with methamphetamine abuse. BACKGROUND: About 7[percnt] of acute parkinsonism may be secondary to medication or drug exposure. Classically, neuroleptics and anti-emetics have been implicated, as well as the toxic byproduct MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), known to destroy dopaminergic neurons when accidentally manufactured in street drugs. Methamphetamine use has been shown to increase the risk of developing Parkinson disease by three-fold, however, flagrant necrosis of the basal ganglia is a less established complication. We describe the case of a 29-year-old female who developed parkinsonism from acute bilateral basal ganglia necrosis caused from crystal meth abuse. DESIGN/METHODS: Case report/clinical, radiologic, photographic. RESULTS: A 29-year-old with a history of polysubstance abuse presented with lethargy, confusion, and mutism. Examination was notable for marked facial hypomimia, extreme bradyphrenia and bradykinesia. She was essentially anarthric and demonstrated only a weak cough. Her muscle tone was normal but gait was slow, narrow-based, shuffling, with en block turns. MRI was performed which showed bilateral basal ganglia edema and necrosis. Infectious workup with blood cultures and CSF studies were all negative. She was started on a Sinemet trial with slight improvement in her symptoms. She was also treated with steroids which reduced radiographic appearance of cerebral edema. She was able to be discharged to rehab and continued to have some improvement, but still requires full-time caregiver assistance. Her drug screen proved to be amphetamine positive and she ultimately admitted to crystal meth use as the precipitant. CONCLUSION: Illicit drug use may have basal ganglia toxicity and produce clinical parkinsonism. Our case was distinct for the marked basal ganglia edema and necrosis on presentation, and association with crystal meth abuse. Awareness of this potential toxicity may help with appropriate diagnosis and counseling.

Disclosure: Dr. Yancey has nothing to disclose.