People with spinal cord injury (SCI) who use classical serotonergic psychedelics such as psilocybin and LSD often experience intense muscle spasms, sweating, and tremors, a phenomenon not previously described in academic literature. These symptoms resemble a peripherally dominant serotonin syndrome-like clinical picture and can interfere with any beneficial effects. The authors propose a theoretical framework for this hypersensitivity and call for awareness to guide harm reduction, informed consent, and development of protocols that allow safe use of psychedelic-assisted therapy in this population.
Ketamine does not significantly impair cerebral pressure-flow dynamics in patients with moderate to severe traumatic brain injury (TBI), challenging historical concerns that it might raise intracranial pressure (ICP). A retrospective study of 122 patients (17 who received ketamine, 105 who did not) found higher median ICP in the ketamine group (14.00 mmHg vs. 9.05 mmHg), but this difference likely reflects greater injury severity rather than a drug effect. No other measures of cerebral physiology—including cerebral perfusion pressure, oxygen delivery, intracranial compliance, or cardiovascular reactivity—differed between groups or changed with incremental ketamine doses. Ketamine remains a viable sedative option for TBI.