9.4.2 Respiratory
Pulmonary fibrosis, right ventricular
hypertrophy and pulmonary hypertension are frequently
found at post-mortem examination.
Pulmonary function tests usually are normal except for
the carbon monoxide diffusing capacity. Respiratory
complications are sometimes caused by fillers or
adulterants used in injections by chronic users. These
can cause multiple microemboli to the lung, which can
lead to restrictive lung disease.
Pneumomediastinum has been reported after amphetamine
inhalation (Brust, 1993).
9.4.3 Neurological
9.4.3.1 Central nervous system (CNS)
Main symptoms include agitation,
confusion, delirium, hallucinations,
dizziness, dyskinesia, hyperactivity, muscle
fasciculation and rigidity, rigors, tics,
tremors, seizures and coma.
Both occlusive and haemorrhagic strokes have
been reported after abuse of amphetamines.
Twenty-one of 73 drug-using young persons
with stroke had taken amphetamine (Kaku &
Lowenstein, 1990), of whom six had documented
intracerebral haemorrhage and two had
subarachnoid haemorrhage. Patients with
underlying arteriovenous malformations may be
at particular risk (Selmi et al., 1995).
Stroke can occur after oral, intravenous, or
nasal administration. Severe headache
beginning within minutes of ingestion of
amphetamine is usually the first symptom. In
more than half the cases, hypertension which
is sometimes extreme, accompanies other
symptoms. A Cerebral vasculitis has also been
observed (Brust, 1993).
Dystonia and dyskinesia can occur, even with
therapeutic dosages (Mattson & Calverley,
1968).
Psychiatric effects, particularly euphoria
and excitement, are the motives for abuse.
Paranoia and a psychiatric syndrome
indistinguishable from schizophrenia are
sequelae of chronic use ( Hall et al., 1988;
Flaum & Schultz, 1996; Johnson & Milner,
1966).
