MDMA Poisoning

MDMA causes excessive release of serotonin, dopamine and noradrenaline, producing marked CNS stimulation and hyperthermia. Severe intoxication may trigger ADH-mediated water retention and hyponatraemia, leading to cerebral oedema, seizures, raised intracranial pressure, brain herniation and death. Neuroimaging studies in MDMA users have also demonstrated alterations involving the globus pallidus, reflecting the vulnerability of deep grey-matter structures to its neurotoxic effects. Unlike carbon monoxide poisoning, however, MDMA has no single characteristic gross brain lesion, and findings must be interpreted with the clinical and toxicological evidence.