Abstract Details

Title Sever Toxic Leucoencephalopathy Following Cocaine Abuse

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 202

Objective

Background BACKGROUND: The prevalence of toxic encephalopathy is unknown, however it is increasingly recognized among patients with neurobehavioral disturbances after exposure to toxins. We report a 52-year old woman with severe diffuse leukoencephalopathy after cocaine abuse. Drug-induced leukoencephalopathy should be part of the differential diagnosis among patients presenting with acute or chronic neurobehavioral deficits and who has potential or known exposure to toxic agents.

Design/Methods DESIGN/METHODS: This is a case report where extensive review of history and laboratory evaluation for extensive leukoencephalopathy was performed.

Results RESULTS: This is a 52-year old woman presenting with acute encephalopathy characterized by self-destructive behavior initially evaluated for suicidal attempts. She deteriorated, later presenting with lethargy, confusion, inattention, memory loss and emotional lability. Infectious work-up, CSF and EEG were all unrevealing. Brain MRI revealed extensive white matter changes consistent with leukoencephalopathy, while spectroscopy demonstrated diminished n-acetylaspartate (NAA) and elevated choline. Extensive work-up remained unremarkable except for cocaine in her urine.

Conclusions CONCLUSIONS: Imaging in the acute setting of cocaine-induce leukoecephalopathy is difficult because of the insidious onset of symtoms. Patients often times are obtunded, unable or unwilling to admit illicit drug use. Brain MRI and spectroscopy are both useful in the evaluation of drug-induced leukoencephalopathy, especially in the setting of cocaine toxicity. The most distinguishing MRI feature of cocaine-induced leukoencephalopathy is the diffuse symmetric prolonged T2 signal within the white matter. Spectroscopy is useful in showing breakdown in energy metabolism at the cellular level with decreased NAA and increased choline level. Awareness of cocaine-induced leukoencephaloptahy should be added in the differential diagnosis of white matter disorders.

Authors/Disclosures
Yasmin A. O'Keefe (OSF Saint Francis Medical Center) PRESENTER	Dr. O'Keefe has nothing to disclose.
Reuben M. Valenzuela, MD (HSHs St. John's Multiple sclerosis center)	No disclosure on file
Jorge C. Kattah, MD, FAAN (University of Illinois College of Medicine at Peoria)	Dr. Kattah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonezzi, Switzer , Poilitto and Hupp Legal Firm.
Olof Harlin	No disclosure on file

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