title: Subcortical hemorrhage caused by methamphetamine abuse: efficacy of the triage system in the differential diagnosis--case report.
abstract: A 32-year-old woman was brought to the emergency room with hemiplegia on the left and consciousness disturbance. Her prior medical history and the circumstances of the onset were unknown. Brain computed tomography showed intracerebral hemorrhage (ICH) with a midline shift of more than 10 mm in the right parietal lobe. Cerebral angiography failed to show any vascular anomalies. Urine analysis with the triage system, a qualitative screening test for psychotropic drug abuse, showed positive reaction for amphetamines. Subsequent laboratory examination confirmed a highly elevated serum concentration of methamphetamine. The patient underwent evacuation of the hemorrhage via a craniotomy, and was discharged 40 days after admission. Abuse of illegal drugs including amphetamines among young adults is increasing in many developed countries, and the suspicion of possible drug abuse should always be raised in young patients with angiographically negative ICH. A urinalysis screening test for psychotropic agents should be a part of routine emergency room diagnostic procedures for such patients.
authors.affiliation: Department of Neurosurgery, National Tokyo Medical Center, Tokyo, Japan. GInamasu@aol.com
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Saito
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuroshima
authors.forename: Keita
authors.initials: K
authors.lastname: Mayanagi
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ohba
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ichikizaki
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002540:Cerebral Cortex; D002543:Cerebral Hemorrhage / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008694:Methamphetamine / Q000009:adverse effects*; D011619:Psychotropic Drugs / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis; D014218:Triage
chemical_list: D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs; D008694:Methamphetamine