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Erschienen in: Rechtsmedizin 3/2019

22.02.2019 | Hirnödem | Leitthema

Neurohistopathologie des Drogentodes

verfasst von: Prof. Dr. A. Büttner

Erschienen in: Rechtsmedizin | Ausgabe 3/2019

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Zusammenfassung

Bei Drogenkonsumenten lässt sich ein breites Spektrum an Veränderungen im zentralen Nervensystem (ZNS) nachweisen. Die häufigsten Befunde resultieren aus ischämisch-hypoxischen Schädigungen und zerebrovaskulären Ereignissen. Systematische histologische, immunhistochemische und morphometrische Untersuchungen an polytoxikomanen Drogentoten konnten tiefgreifende morphologische Veränderungen nachweisen. Diese umfassen einen Nervenzellverlust, neurodegenerative Veränderungen, eine Abnahme der GFAP(„glial fibrillary acidic protein“)-positiven Astrozyten, eine ausgedehnte axonale Schädigung mit begleitender Mikrogliaaktivierung sowie reaktive und degenerative Veränderungen der zerebralen Mikrovaskulatur. Bei langfristigem Missbrauch von Amphetaminen, Methamphetamin und MDMA („Ecstasy“; 3,4-Methylendioxy-N-methylamphetamin) wurde eine Neurotoxizität mit einem erhöhten Risiko für das Entstehen eines Morbus Parkinson postuliert, das jedoch noch nicht eindeutig belegt wurde.
Literatur
1.
Zurück zum Zitat Andersen SN, Skullerud K (1999) Hypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts. Forensic Sci Int 102:51–59CrossRef Andersen SN, Skullerud K (1999) Hypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts. Forensic Sci Int 102:51–59CrossRef
2.
Zurück zum Zitat Anthony IC, Norrby KE, Dingwall T, Carnie FW, Millar T, Arango JC, Robertson R, Bell JE (2010) Predisposition to accelerated Alzheimer-related changes in the brains of human immunodeficiency virus negative opiate abusers. Brain 133:3685–3698CrossRef Anthony IC, Norrby KE, Dingwall T, Carnie FW, Millar T, Arango JC, Robertson R, Bell JE (2010) Predisposition to accelerated Alzheimer-related changes in the brains of human immunodeficiency virus negative opiate abusers. Brain 133:3685–3698CrossRef
3.
Zurück zum Zitat Bell JE, Arango JC, Robertson R, Brettle RP, Leen C, Simmonds P (2002) HIV and drug misuse in the Edinburgh cohort. J Acquir Immune Defic Syndr 31:S35–S42CrossRef Bell JE, Arango JC, Robertson R, Brettle RP, Leen C, Simmonds P (2002) HIV and drug misuse in the Edinburgh cohort. J Acquir Immune Defic Syndr 31:S35–S42CrossRef
4.
Zurück zum Zitat Brust JCM (1993) Clinical, radiological, and pathological aspects of cerebrovascular disease associated with drug abuse. Stroke 24:129–133 Brust JCM (1993) Clinical, radiological, and pathological aspects of cerebrovascular disease associated with drug abuse. Stroke 24:129–133
5.
Zurück zum Zitat Büttner A (2011) The neuropathology of drug abuse. Neuropathol Appl Neurobiol 37:118–134CrossRef Büttner A (2011) The neuropathology of drug abuse. Neuropathol Appl Neurobiol 37:118–134CrossRef
6.
Zurück zum Zitat Büttner A, Weis S (2006) Neuropathological alterations in drug abusers—The involvement of neurons, glial and vascular systems. Forensic Sci Med Pathol 2:115–126CrossRef Büttner A, Weis S (2006) Neuropathological alterations in drug abusers—The involvement of neurons, glial and vascular systems. Forensic Sci Med Pathol 2:115–126CrossRef
7.
Zurück zum Zitat Büttner A, Weis S (2004) Central nervous system alterations in drug abuse. In: Tsokos M (Hrsg) Forensic pathology reviews, Bd. 1. Humana Press, Totowa, S 79–136CrossRef Büttner A, Weis S (2004) Central nervous system alterations in drug abuse. In: Tsokos M (Hrsg) Forensic pathology reviews, Bd. 1. Humana Press, Totowa, S 79–136CrossRef
8.
Zurück zum Zitat Connor MD, Lammie GA, Bell JE, Warlow CP, Simmonds P, Brettle RP (2000) Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV autopsy cohort. Stroke 31:2117–2126CrossRef Connor MD, Lammie GA, Bell JE, Warlow CP, Simmonds P, Brettle RP (2000) Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV autopsy cohort. Stroke 31:2117–2126CrossRef
9.
Zurück zum Zitat Dargan PI, Wood DM (2013) Novel psychoactive substances: classification, pharmacology and toxicology. Academic Press, Elsevier, London, UK Dargan PI, Wood DM (2013) Novel psychoactive substances: classification, pharmacology and toxicology. Academic Press, Elsevier, London, UK
10.
Zurück zum Zitat Davis GD, Swalwell CI (1996) The incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured cerebral (berry) aneurysms. J Forensic Sci 41:626–628CrossRef Davis GD, Swalwell CI (1996) The incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured cerebral (berry) aneurysms. J Forensic Sci 41:626–628CrossRef
11.
Zurück zum Zitat Ersche KD, Jones PS, Williams GB, Robbins TW, Bullmore ET (2013) Cocaine dependence: a fast-track for brain ageing? Mol Psychiatry 18:134–135CrossRef Ersche KD, Jones PS, Williams GB, Robbins TW, Bullmore ET (2013) Cocaine dependence: a fast-track for brain ageing? Mol Psychiatry 18:134–135CrossRef
12.
Zurück zum Zitat Fessler RD, Esshaki CM, Stankewitz RC, Johnson RR, Diaz FG (1997) The neurovascular complications of cocaine. Surg Neurol 47:339–345CrossRef Fessler RD, Esshaki CM, Stankewitz RC, Johnson RR, Diaz FG (1997) The neurovascular complications of cocaine. Surg Neurol 47:339–345CrossRef
13.
Zurück zum Zitat Fineschi V, Centini F, Mazzeo E, Turillazzi E (1999) Adam (MDMA) and Eve (MDEA) misuse: an immunohistochemical study on three fatal cases. Forensic Sci Int 104:65–74CrossRef Fineschi V, Centini F, Mazzeo E, Turillazzi E (1999) Adam (MDMA) and Eve (MDEA) misuse: an immunohistochemical study on three fatal cases. Forensic Sci Int 104:65–74CrossRef
14.
Zurück zum Zitat Gill JR, Hayes JA, deSouza IS, Marker E, Stajic M (2002) Ecstasy (MDMA) deaths in New York City: a case series and review of the literature. J Forensic Sci 47:121–126PubMed Gill JR, Hayes JA, deSouza IS, Marker E, Stajic M (2002) Ecstasy (MDMA) deaths in New York City: a case series and review of the literature. J Forensic Sci 47:121–126PubMed
15.
Zurück zum Zitat Gosztonyi G, Schmidt V, Nickel R, Rothschild MA, Camacho S, Siegel G, Zill E, Pauli G, Schneider V (1993) Neuropathologic analysis of postmortal brain samples of HIV-seropositive and -seronegative i. v. drug addicts. Forensic Sci Int 62:101–105CrossRef Gosztonyi G, Schmidt V, Nickel R, Rothschild MA, Camacho S, Siegel G, Zill E, Pauli G, Schneider V (1993) Neuropathologic analysis of postmortal brain samples of HIV-seropositive and -seronegative i. v. drug addicts. Forensic Sci Int 62:101–105CrossRef
16.
Zurück zum Zitat Gouzoulis-Mayfrank E, Daumann J (2006) Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage? Addiction 101:348–361CrossRef Gouzoulis-Mayfrank E, Daumann J (2006) Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage? Addiction 101:348–361CrossRef
17.
Zurück zum Zitat Hess C, Maas A, Madea B (2014) „Legal highs“. Chemie, Pharmakologie, Toxikologie und forensische Bedeutung. Rechtsmedizin 24:291–305CrossRef Hess C, Maas A, Madea B (2014) „Legal highs“. Chemie, Pharmakologie, Toxikologie und forensische Bedeutung. Rechtsmedizin 24:291–305CrossRef
18.
Zurück zum Zitat Karch SB, Drummer OH (2016) Karch’s pathology of drug abuse, 5. Aufl. CRC Press, Boca Raton, London, New York Karch SB, Drummer OH (2016) Karch’s pathology of drug abuse, 5. Aufl. CRC Press, Boca Raton, London, New York
19.
Zurück zum Zitat Karch SB, Stephens BG, Ho CH (1999) Methamphetamine-related deaths in San Francisco: demographic, pathologic, and toxicologic profiles. J Forensic Sci 44:359–368CrossRef Karch SB, Stephens BG, Ho CH (1999) Methamphetamine-related deaths in San Francisco: demographic, pathologic, and toxicologic profiles. J Forensic Sci 44:359–368CrossRef
20.
Zurück zum Zitat Kelly MA, Gorelick PB, Mirza D (1992) The role of drugs in the etiology of stroke. Clin Neuropharmacol 15:249–275CrossRef Kelly MA, Gorelick PB, Mirza D (1992) The role of drugs in the etiology of stroke. Clin Neuropharmacol 15:249–275CrossRef
21.
Zurück zum Zitat Kish SJ (2002) How strong is the evidence that brain serotonin neurons are damaged in human users of ecstasy? Pharmacol Biochem Behav 71:845–855CrossRef Kish SJ (2002) How strong is the evidence that brain serotonin neurons are damaged in human users of ecstasy? Pharmacol Biochem Behav 71:845–855CrossRef
22.
Zurück zum Zitat Kovacs GG, Horvath MC, Majtenyi K, Lutz MI, Hurd YL, Keller E (2015) Heroin abuse exaggerates age-related deposition of hyperphosphorylated tau and p62-positive inclusions. Neurobiol Aging 36:3100–3107CrossRef Kovacs GG, Horvath MC, Majtenyi K, Lutz MI, Hurd YL, Keller E (2015) Heroin abuse exaggerates age-related deposition of hyperphosphorylated tau and p62-positive inclusions. Neurobiol Aging 36:3100–3107CrossRef
23.
Zurück zum Zitat Logan BK, Fligner CL, Haddix T (1998) Cause and manner of death in fatalities involving methamphetamine. J Forensic Sci 43:28–34PubMed Logan BK, Fligner CL, Haddix T (1998) Cause and manner of death in fatalities involving methamphetamine. J Forensic Sci 43:28–34PubMed
24.
Zurück zum Zitat Makrigeorgi-Butera M, Hagel C, Laas R, Püschel K, Stavrou D (1996) Comparative brain pathology of HIV-seronegative and HIV-infected drug addicts. Clin Neuropathol 15:324–329PubMed Makrigeorgi-Butera M, Hagel C, Laas R, Püschel K, Stavrou D (1996) Comparative brain pathology of HIV-seronegative and HIV-infected drug addicts. Clin Neuropathol 15:324–329PubMed
25.
Zurück zum Zitat Mash DC, Ouyang Q, Pablo J, Basile M, Izenwasser S, Lieberman A, Perrin RJ (2003) Cocaine users have an overexpression of α‑synuclein in dopamine neurons. J Neurosci 23:2564–2572CrossRef Mash DC, Ouyang Q, Pablo J, Basile M, Izenwasser S, Lieberman A, Perrin RJ (2003) Cocaine users have an overexpression of α‑synuclein in dopamine neurons. J Neurosci 23:2564–2572CrossRef
26.
Zurück zum Zitat McEvoy AW, Kitchen ND, Thomas DGT (2000) Intracerebral haemorrhage in young adults: the emerging importance of drug misuse. BMJ 320:1322–1324CrossRef McEvoy AW, Kitchen ND, Thomas DGT (2000) Intracerebral haemorrhage in young adults: the emerging importance of drug misuse. BMJ 320:1322–1324CrossRef
27.
Zurück zum Zitat Milroy CM, Clark JC, Forrest ARW (1996) Pathology of deaths associated with “ecstasy” and “eve” misuse. J Clin Pathol 49:149–153CrossRef Milroy CM, Clark JC, Forrest ARW (1996) Pathology of deaths associated with “ecstasy” and “eve” misuse. J Clin Pathol 49:149–153CrossRef
28.
Zurück zum Zitat Mittleman RE, Wetli CV (1987) Cocaine and sudden “natural” death. J Forensic Sci 32:11–19CrossRef Mittleman RE, Wetli CV (1987) Cocaine and sudden “natural” death. J Forensic Sci 32:11–19CrossRef
29.
Zurück zum Zitat Niess C, Müllerklein T, Bratzke H (2001) Pontine Axonschäden bei Drogenkonsumenten. Rechtsmedizin 11:173–174CrossRef Niess C, Müllerklein T, Bratzke H (2001) Pontine Axonschäden bei Drogenkonsumenten. Rechtsmedizin 11:173–174CrossRef
30.
Zurück zum Zitat Nolte KB, Brass LM, Fletterick CF (1996) Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study. Baillieres Clin Neurol 46:1291–1296 Nolte KB, Brass LM, Fletterick CF (1996) Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study. Baillieres Clin Neurol 46:1291–1296
31.
Zurück zum Zitat Oehmichen M, Meißner C, Reiter A, Birkholz M (1996) Neuropathology in non-human immunodeficiency virus-infected drug addicts: hypoxic brain damage after chronic intravenous drug abuse. Acta Neuropathol 91:642–646CrossRef Oehmichen M, Meißner C, Reiter A, Birkholz M (1996) Neuropathology in non-human immunodeficiency virus-infected drug addicts: hypoxic brain damage after chronic intravenous drug abuse. Acta Neuropathol 91:642–646CrossRef
32.
Zurück zum Zitat Oyesiku NM, Colohan ART, Barrow DL, Reisner A (1993) Cocaine-induced aneurysmal rupture: an emergent negative factor in the natural history of intracranial aneurysms? Neurosurgery 32:518–526CrossRef Oyesiku NM, Colohan ART, Barrow DL, Reisner A (1993) Cocaine-induced aneurysmal rupture: an emergent negative factor in the natural history of intracranial aneurysms? Neurosurgery 32:518–526CrossRef
33.
Zurück zum Zitat Pearson J, Richter RW (1979) Addiction to opiates: neurologic aspects. In: Vinken PJ, Bruyn GW (Hrsg) Handbook of clinical neurology. Intoxications of the nervous system, part II. North-Holland Publishing Company, Amsterdam, S 365–400 Pearson J, Richter RW (1979) Addiction to opiates: neurologic aspects. In: Vinken PJ, Bruyn GW (Hrsg) Handbook of clinical neurology. Intoxications of the nervous system, part II. North-Holland Publishing Company, Amsterdam, S 365–400
34.
Zurück zum Zitat Ramage SN, Anthony IC, Carnie FW, Busuttil A, Robertson R, Bell JE (2005) Hyperphosphorylated tau and amyloid precursor protein deposition is increased in the brains of young drug abusers. Neuropathol Appl Neurobiol 31:439–448CrossRef Ramage SN, Anthony IC, Carnie FW, Busuttil A, Robertson R, Bell JE (2005) Hyperphosphorylated tau and amyloid precursor protein deposition is increased in the brains of young drug abusers. Neuropathol Appl Neurobiol 31:439–448CrossRef
35.
Zurück zum Zitat Rizzuto N, Morbin M, Ferrari S, Cavallaro T, Sparaco M, Boso G, Gaetti L (1997) Delayed spongiform leukoencephalopathy after heroin abuse. Acta Neuropathol 94:87–90CrossRef Rizzuto N, Morbin M, Ferrari S, Cavallaro T, Sparaco M, Boso G, Gaetti L (1997) Delayed spongiform leukoencephalopathy after heroin abuse. Acta Neuropathol 94:87–90CrossRef
36.
Zurück zum Zitat Schmidt P, Schmolke C, Mußhoff F, Menzen M, Prohaska C, Madea B (2001) Immunhistochemische Untersuchungen zur delta-Opiatrezeptordichte im Kortex Drogentoter. Ein Humanmodell chronischer Opiatexposition. Rechtsmedizin 11:46–55CrossRef Schmidt P, Schmolke C, Mußhoff F, Menzen M, Prohaska C, Madea B (2001) Immunhistochemische Untersuchungen zur delta-Opiatrezeptordichte im Kortex Drogentoter. Ein Humanmodell chronischer Opiatexposition. Rechtsmedizin 11:46–55CrossRef
37.
Zurück zum Zitat Schmidt P, Oscilowski Z, Schmolke C, Padosch SA, Mußhoff F, Madea B (2005) Zur Zelldichte µ‑Opiatrezeptor-exprimierender hippocampaler Neuronen Drogentoter. Rechtsmedizin 15:18–23CrossRef Schmidt P, Oscilowski Z, Schmolke C, Padosch SA, Mußhoff F, Madea B (2005) Zur Zelldichte µ‑Opiatrezeptor-exprimierender hippocampaler Neuronen Drogentoter. Rechtsmedizin 15:18–23CrossRef
38.
Zurück zum Zitat Sloan MA, Kittner SJ, Feeser BR, Gardner J, Epstein A, Wozniak MA, Wityk RJ, Stern BJ, Price TR, Macko RF, Johnson CJ, Earley CJ, Buchholz D (1998) Illicit drug-associated ischemic stroke in the Baltimore-Washington Young Stroke Study. Baillieres Clin Neurol 19:1688–1693 Sloan MA, Kittner SJ, Feeser BR, Gardner J, Epstein A, Wozniak MA, Wityk RJ, Stern BJ, Price TR, Macko RF, Johnson CJ, Earley CJ, Buchholz D (1998) Illicit drug-associated ischemic stroke in the Baltimore-Washington Young Stroke Study. Baillieres Clin Neurol 19:1688–1693
39.
Zurück zum Zitat Squier MV, Jalloh S, Hilton-Jones D, Series H (1995) Death after ecstasy ingestion: neuropathological findings. J Neurol Neurosurg Psychiatry 58:756CrossRef Squier MV, Jalloh S, Hilton-Jones D, Series H (1995) Death after ecstasy ingestion: neuropathological findings. J Neurol Neurosurg Psychiatry 58:756CrossRef
40.
Zurück zum Zitat Tardiff K, Gross E, Wu J, Stajic M, Millman R (1989) Analysis of cocaine-positive fatalities. J Forensic Sci 34:53–63CrossRef Tardiff K, Gross E, Wu J, Stajic M, Millman R (1989) Analysis of cocaine-positive fatalities. J Forensic Sci 34:53–63CrossRef
41.
Zurück zum Zitat Thrash B, Thiruchelvan K, Ahuja M, Suppiramaniam V, Dhanasekaran M (2009) Methamphetamine-induced neurotoxicity: the road to Parkinson’s disease. Pharmacol Rep 61:966–977CrossRef Thrash B, Thiruchelvan K, Ahuja M, Suppiramaniam V, Dhanasekaran M (2009) Methamphetamine-induced neurotoxicity: the road to Parkinson’s disease. Pharmacol Rep 61:966–977CrossRef
42.
Zurück zum Zitat Tomlinson GS, Simmonds P, Busuttil A, Chiswick A, Bell JE (1999) Upregulation of microglia in drug users with and without pre-symptomatic HIV infection. Neuropathol Appl Neurobiol 25:369–379CrossRef Tomlinson GS, Simmonds P, Busuttil A, Chiswick A, Bell JE (1999) Upregulation of microglia in drug users with and without pre-symptomatic HIV infection. Neuropathol Appl Neurobiol 25:369–379CrossRef
Metadaten
Titel
Neurohistopathologie des Drogentodes
verfasst von
Prof. Dr. A. Büttner
Publikationsdatum
22.02.2019
Verlag
Springer Medizin
Schlagwort
Hirnödem
Erschienen in
Rechtsmedizin / Ausgabe 3/2019
Print ISSN: 0937-9819
Elektronische ISSN: 1434-5196
DOI
https://doi.org/10.1007/s00194-019-0305-7

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