Posterior reversible encephalopathy syndrome is associated with cancer chemotherapy, hypertension, preeclampsia, and abuse of drugs like amphetamine and methamphetamine. A man was reported to have suffered from disorientation, severe headache and aphasia post-consumption of kratom and Adderall. Before treatment, his initial blood pressure was found to be elevated.
Kratom or mitragyna speciosa is a tropical evergreen that is native to Southeast Asia. A member of the Rubiaceae family (Ulbricht), it contains the psychoactive compounds 7-hydroxy mitragynine (7-HMG) and mitragynine (C23H30N2O4, molecular weight 398.49). Though it lacks scientific evidence, Kratom leaves are known to treat chronic pain or opioid withdrawal. Over the years Kratom users have increased in the US, who use it both for self-medicated opioid withdrawal treatment and recreation due to its psychoactive and opioid-like activity. The following is the case presentation of a patient reporting posterior reversible leukoencephalopathy syndrome (PRES) possibly due to the use of Kratom.
A 22-year-old man reported severe headache as throbbing mostly in the back of his head. Unrelieved by acetaminophen, the man also reported dizziness, disorientation and mild confusion. Considering the patient was suffering from insomnia, he was prescribed fluoxetine for depression and quetiapine. The man occasionally misused marijuana and dextroamphetamine. The patient's blood pressure was 180/105 mm Hg, respiratory rate 16 breaths per minute and heart rate 53 beats per minute. He felt uncomfortable but was alert and oriented. A computed tomography (CT) scan of the head was conducted and a possible occipital intraparenchymal hemorrhage was revealed. After being transferred to a hospital facility, during his initial interrogation he was disoriented to place and time, confused and aphasic. His drug screen was positive for amphetamine, cannabinoids, opiates (morphine given in local emergency room) and benzodiazepine (lorazepam was given in local emergency room). His urine had not been tested for kratom. A repeat CT scan of the head was conducted. It revealed bilateral low-density changes consistent with edema in both cerebellar hemispheres and both occipital lobes.
Also, consistent edema in both parietal lobes consistent with PRES and a left occipitoparietal intraparenchymal bleed. An MRI of his head revealed gyri form enhancement, multifocal areas of abnormal T2 fluid-attenuated inversion recovery signal, restricted diffusion in the superior parietal lobes, both occipital lobes, and both cerebellar hemispheres and minimal hemorrhage in the left superior parietal lobe consistent with atypical PRES. Eventually, the patient reported that he had abused kratom of an unknown amount and consumed six tablets of dextroamphetamine before admission. After 5 days of being hospitalized, his headache improved steadily. When he was discharged, his blood pressure and his neurological examination were normal.
Kratom is a growingly popular herbal remedy for many diseases but again it lacks published investigations or any scientific evidence. There are many toxic effects of Kratom like changes in urination, dry mouth, nausea, weight loss, vomiting. Coma and seizures have also been reported. You can buy Kratom from Apex Kraton. Just remember; its medicinal benefits but remember its effects are dose-dependent. For instance, large doses may produce morphine-like sedative effects while small doses may cause cocaine-like effects. Kratom is recommended as users have reported alertness, increased work capacity, sociability and also sometimes increased sexual desire. Buy Kratom and take it according to the prescribed doses only.
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