Neurotoxicity following chronic intravenous use of “Russian Cocktail”

Introduction. Recently, neurological abnormalities in methcathinone users have been attributed to manganese. We report similar toxicity in three patients following the use of a mixture similar to methcathinone: potassium permanganate, ephedrine, and aspirin. Case Reports. Three teenagers (15 to 19 years old) presented with extrapyramidal abnormalities and movement disorders following chronic intravenous use of a mixture known as “Russian Cocktail”. All three patients had multiple movement disorders. One patient had normal blood manganese concentration (<19 μg/L) and MRI. The other two had elevated blood manganese (2100 μg/L and 3176 μg/L) and MRIs showing bilateral symmetric hyper-intensities on T1-weighted-images in the dentate nucleus, subcortical white substance of cerebellar hemisphere, globus pallidus, and putamen. Abstinence and treatment with EDTA, levodopa, and para-aminosalicylic acid was associated with decreasing blood manganese concentrations and subjective improvement, but no change in object...