Objective:

To report a case of reversible ischemic changes on MRI associated with chronic kratom use in a patient presenting with encephalopathy and seizures

Background:

Mitragyna speciosa, or kratom, is a psychoactive substance that targets multiple opioid receptors and has been an unregulated and under-reported substance of abuse. Its use has been reported to cause  liver toxicity, respiratory depression, neuropsychiatric issues and even death. Its neurological side effects at this time are not well established.

Design/Methods:

We report a case of a 23-year-old male with a medical history significant for polysubstance abuse who presented for acute encephalopathy and seizure-like episode, requiring ICU admission and intubation for airway protection.

Results:

Patient initially presented with hypotension , leukocytosis, and lactic acidosis concerning sepsis. He  was started on broad spectrum antibiotics for meningitis coverage and Keppra to prevent further seizures. Urine toxicology screen was negative. Once examined  off sedation, the patient was noted to have right upper extremity weakness with babinski reflex on right concerning stroke therefore an MRI was obtained. It revealed small areas of confluent juxtacortical white matter abnormality high in the posterior frontal lobes bilaterally with some true diffusion restriction on the left suggestive of acute infarct. However, the appearance was  unusual for a stroke. Further history from the family revealed that the patient uses Kratom on a daily basis for a number of years to help with anxiety. He had no further seizures and his mental status improved during the remainder of his hospitalization. Repeat MRI Brain 2 months after initial presentation  showed resolution of  the abnormalities.

Conclusions:

Kratom has been reported in the past to cause neurological issues like seizures or PRES. This case shows reversible ischemic  neuroimaging findings of Kratom use in a patient with a stroke-like presentation.