Methylcathinone -- "the king of legal highs" and manganese encephalopathy.

Methylcathinone is a psychostimulant that increases the release of dopamine and norepinephrine in the brain. Ephedrone - methylcathinone obtained using "home" methods - is produced by the oxidation of drugs containing ephedrine. Methylcathinone itself is relatively low toxic, while the side effect of ephedrone is dementia, and parkinsonian and pyramidal syndromes. Case report: After 3 months of intravenous use of ephedrone, a 25-year-old woman developed gait disturbances with falls, followed by dysphagia, dysarthria, symptoms of multifocal dystonia and parkinsonian syndrome. Despite discontinuing the use of ephedrone, the symptoms gradually worsened, which led to the patient's immobilization in a wheelchair and her death 8 years later. Microscopic examination of the patient's brain was performed using routine histopathological methods, TUNEL method, and immunohistochemical reactions with antibodies against: ubiquitin, β-amyloid, α-synuclein, tau protein, GFAP ferritin, C4β complement, and CD3, CD45, CD68 antigens. Histopathological examinations revealed changes already described previously with manganese poisoning, such as: loss of neurons in the globus pallidus, reactive gliosis in the substan-tia nigra and excessive accumulation iron deposits in astroglia in the basal ganglia. In addition, abnormalities not occurring in manganism were also found, such as: generalized inflammation of small cerebral vessels of moderate severity and the presence of unknown material in the lumen of microvessels. Some astrocytes and neurons showed immunoreactivity in the TUNEL method. No signs of neurodegenerative process were found in the structures of the nigro-striatal system and striatum. Conclusions: Ephedrone's neurotoxicity is only partially due to manganese poisoning and it may also cause vasculitis, possibly following intravenous administration. [ABSTRACT FROM AUTHOR]