BMJ Case Reports 2009; doi:10.1136/bcr.08.2008.0669
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin

  1. Nilo Riva1,
  2. Nilo Riva1,
  3. Paolo Morana2,
  4. Federica Cerri2,
  5. Simonetta Gerevini1,
  6. Stefano Amadio2,
  7. Fabio Formaglio2,
  8. Giancarlo Comi2,
  9. Mauro Comola2,
  10. Ubaldo Del Carro2
  1. 1
    San Raffaele Scientific Institute, Department of Neuroradiology, Via Olgettina 60, Milan, 20132, Italy
  2. 2
    San Raffaele Scientific Institute, Department of Neurology, Neuro-rehabilitation and Clinical Neurophysiology, via Olgettina 48, Milan, 20132, Italy
  1. riva.nilo{at}
  • Published 23 January 2009


We report a patient who developed acute myelopathy after intranasal insufflation of amphetamines and heroin. The functional prognosis was very poor; after 4 months, she remained paraplegic. MRI imaging showed selective T2 hyperintensity and intense enhancement confined to the spinal anterior horns and lumbar nerve roots and plexus. This unique MRI pattern, together with neurophysiological data, suggests that the pathological process at the first primary affected spinal anterior horns (SAH), conditioning motoneuron cell death, and then nerve roots and lumbar plexus as a consequence of wallerian degeneration


  • Competing interests: None.

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