ABSTRACT
Abstract Introduction: There has been a rising interest in ketamine as a promising treatment for refractory depression. Despite this, there is uncertain knowledge regarding aspects of the routinary use of ketamine for treating depression, such as optimal doses, long term toxicity, abuse potential in depressed patients, probable adverse effects associated with antidepressant drugs, the indication of ketamine in psychotic patients, and the ethical concerns of ketamine use. Clinical case: A 63 year-old woman with a psychotic depressive episode, catatonic features, cardiovascular disease (patent foramen ovale and atrial fibrillation) , and starvation risk because she refused food intake. She was sent to electroconvulsive therapy (ECT) after several weeks of oral administration of benzodiazepine, antipsychotic, and antidepressant medications; the patient presented no improvement, but she was rejected due to her cardiovascular comorbidity. Two IV Ketamine doses were used as a life-saving strategy with good clinical response, mainly in terms of the catatonic features. The ketamine treatment was not only effective but also well tolerated. Discussion: Despite the little information regarding its use in psychotic and catatonic patients, this case would suggest that it remains effective and safe, as well as a good option for patients with cardiovascular disease and those who cannot use electroconvulsive therapy.
ABSTRACT
Leukoencephalopathy is a myelin disorder caused by multiple agents, including substance abuse. A 28-year-old man arrived at the emergency department having suffered from asthenia, dizziness, disorientation and ataxia for two months. He had a two-year history of heroin inhalation. He arrived in a normal physical condition. Brain magnetic resonance showed bilateral diffuse hypointense lesions in the white matter. At day 3 after admission, he presented neurological deterioration, stupor, haemodynamic instability, respiratory failure, and died. Toxic leukoencephalopathy symptoms start with inattention, memory and personality changes, and may eventually cause dementia and death. Heroin inhalation is a common practice and can lead to leukoencephalopathy. Leukoencephalopathy associated with heroin inhalation is a rare entity that mainly affects young adults and has a high social impact. Its aetiology is unclear, it has no effective treatment and there is a high mortality rate. Heroin consumption is on the rise in Colombia, so TL should be considered by medical staff.
La leucoencefalopatía es una patología de la mielina producida por múltiples agentes, incluidas las sustancias de abuso. Un varón de 28 años llegó urgencias por 2 meses de astenia, mareo, desorientación y ataxia. Tenía antecedentes de consumo inhalado de heroína por 2 años. Presentaba condiciones físicas regulares. La resonancia magnética cerebral mostró lesiones hipointensas difusas bilaterales en la sustancia blanca. Al tercer día presentó empeoramiento de su estado neurológico, estupor, inestabilidad hemodinámica, insuficiencia respiratoria y muerte. Los síntomas de leucoencefalopatía tóxica (LT) comienzan con falta de atención, cambios en la memoria y la personalidad, y finalmente demencia y muerte. El consumo de heroína inhalada es una práctica frecuente con riesgo de que produzca LT. La leucoencefalopatía asociada con el uso de heroína inhalada es una entidad rara que afecta principalmente a adultos jóvenes y tiene un alto impacto social. Su etiología no está clara, no tiene un tratamiento efectivo y tiene altas tasas de mortalidad. El consumo de heroína está aumentando en Colombia, por lo que el personal médico debe tener en cuenta la LT.