RESUMEN
We report about a 25-year-old patient with transnasal ketamine abuse over years presenting with severe irritative urinary dysfunction (imperative urinary urgency, pollakisuria, dysuria) and severe alguria. Cystoscopia showed ketamine-induced vesicopathy with errosive cystitis; other etiologies could be excluded. Despite serious effort the patient was not motivated for abstinence from ketamine. After two ineffecient therapies with botulinum toxin A (200 and 400â I.âE.) injected into the bladder, a prostate preserving cystectomia and ileum neobladder were mandatory.
Asunto(s)
Analgésicos/efectos adversos , Ketamina/efectos adversos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Urinarios/inducido químicamente , Administración Intranasal , Administración Intravesical , Adulto , Analgésicos/administración & dosificación , Toxinas Botulínicas Tipo A/administración & dosificación , Cistectomía , Cistitis/inducido químicamente , Cistitis/diagnóstico , Cistitis/rehabilitación , Seropositividad para VIH/fisiopatología , Seropositividad para VIH/psicología , Humanos , Ketamina/administración & dosificación , Masculino , Cooperación del Paciente/psicología , Trastornos Relacionados con Sustancias/rehabilitación , Derivación Urinaria , Trastornos Urinarios/diagnóstico , Trastornos Urinarios/rehabilitaciónRESUMEN
We report the case of a patient who developed acute transient psychosis after implantation, but not activation of pallidal deep brain electrodes for generalised dystonia. Psychotic symptoms coincided temporally with postoperative motor improvement induced by the microlesion effect after electode implantation. This finding suggests that the microlesion effect may not be confined to motor improvement, but also comprises non-motor symptoms. In our case, affection of adjacent dopaminergic fibres of passages has to be assumed.