Nexus (2C-B) Associated with Significant Cerebral Vasospasm

May 10, 2010, 8:55 pm

★★½☆☆

Cerebral Vasculopathy After 4-Bromo-2,5-Dimethoxyphenethylamine Ingestion. Ambrose JB et al.  The Neurologist May 2010;16:199-202.

Abstract

4-bromo-2,5-dimethoxyphenethylamine (2C-B) is a psychedelic phenethylamine first synthesized in the 1970s and subsequently used as a replacement for — or addition to — “ecstasy” at rave events.  It stimulates both the alpha-1 and serotonin 5-HT2 receptors, producing vasospasm and vivid visual hallucinations. Street names for 2C-B include nexus, Venus, Erox, bees, and bromo mescaline.

This interesting case report, from UC-San Francisco, describes a 43-year-old woman who developed profound persistent neurological deficits — including encephalopathy and quadraparesis — after ingesting a liquid at a party that was reportedly 2C-B made from a recipe found on the internet.  Two days later she developed a severe headache and mental status changes, followed by progressive weakness and hyperreflexia. Cerebral MRI and angiography revealed infarction in  watershed areas and diffuse focal vascular narrowing.  Extensive laboratory evaluation showed no evidence of infectious or autoimmune etiology.

The authors are quite right to note this case demonstrates only an “association”, not a cause-and-effect relationship.  The time course over which symptoms presented is certainly surprising: onset of headache was 48 hours after ingesting the liquid, and weakness progressed over weeks.  In addition, no testing was done to establish that the liquid ingested was indeed 2C-B and did not contain any important contaminants.  Apparently, other people at the party ingested the same liquid without adverse effects.  We really don’t know whether this was an idiosyncratic reaction to 2C-B,  a result of ingesting a large dose, or a process completely unrelated to 2C-B.

Addendum: [May 11, 2010 12:21 pm]  On further thought, I realized the obvious point that this paper does not really show even an “association” between 2C-B and the profound neurological deficits this patient developed, since the authors never demonstrated that 2C-B was involved at all.  Therefore, I downgraded this article from the original rating of 3.5 skulls.

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