Disclosures: David Knight, DO: No financial relationships or conflicts of interest

Case Diagnosis: Spinal Cord Infarction secondary to K2 Toxicity

Case Description or Program Description: A 51-year-old male with a history of schizoaffective disorder and diabetes mellitus presents with 2 days of bilateral lower extremity pain and weakness as well as constipation with urinary retention after smoking synthetic marijuana (K2). Pertinent exam findings include absent strength, sensation and deep tendon reflexes in his lower extremities. Labs revealed a mildly elevated CSF protein on a lumbar puncture, but negative autoimmune workup as well as an unremarkable paraneoplastic encephalitis panel. Head imaging was unremarkable. MRI of the spine revealed extensive intramedullary T2 hyperintensity with preferential involvement of the central gray matter zone from C4 to T11.

Setting: University of Rochester Medical Center

Assessment/Results: Patient’s presentation was initially thought inflammatory with a running diagnosis of transverse myelitis secondary to K2 toxicity given his negative infectious, autoimmune and paraneoplastic workup. He was treated with IV steroids followed by plasmapheresis but was without any motor or sensory return in his lower extremities or improvement in his bowel/bladder dysfunction. Repeat MRI imaging of the spine revealed resolution of the lesions in his cervical spine and no change to the thoracic lesions. He was ultimately diagnosed with a spinal cord infarction secondary to K2 toxicity. Plan currently is for spinal cord injury rehabilitation to optimize his bowel/bladder function, maximize his independence once cleared from a medical perspective.

Discussion (relevance): While there have been reports of ischemic strokes from synthetic marijuana use, there have been no reported cases of spinal cord infarctions from synthetic marijuana. While it cannot be confirmed with a single test, a thorough medical workup should be completed to rule out more common causes of spinal cord infarctions.

Conclusions: As described above, synthetic marijuana use may result in a significant injury. Education of K2’s catastrophic side effects should be given to those who partake.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unfortunate-consequence-to-synthetic-marijuana-k2/