Abstract Details

Title A Case of Suspected Bilateral Ophthalmic Artery Occlusion, Spinal Cord Infarction, and Agranulocytosis in a Cocaine User

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 234

Objective

Background BACKGROUND: Cocaine use is associated with vascular complications, including ischemic infarcts, hemorrhagic infarcts, and central retinal artery occlusion. Levamisole is a cocaine adulterant that is used either as a cutting agent or for possible pharmacological effects. It can cause reversible agranulocytosis and cutaneous vasculitis.

Design/Methods DESIGN/METHODS: We describe the clinical presentation and results of relevant diagnostic testing, including computed tomography angiography (CTA) and magnetic resonance imaging (MRI).

Results RESULTS: A 50-year-old male who frequently smoked crack cocaine presented with progressive binocular vision loss (right then left) and left lower back pain and numbness with subsequent development of bilateral lower extremity paralysis, loss of sensation, and urinary retention. Ophthalmological examination revealed dilated and non-reactive pupils, absence of light perception in both eyes, disc edema, attenuated arteries, and venous engorgement as well as delayed filling and disc leakage on intravenous fluorescein angiography. Laboratory work-up was notable for an ANC of 0, mildly elevated ESR/CRP, elevated anti-cardiolipin antibodies, positive rheumatoid factor, elevated dsDNA, positive HLA-B27, and positive p-ANCA. Serum and CSF NMO-antibody were both negative. Head CTA showed right ophthalmic artery narrowing with a nearly occluded mid-portion. While initial head MRI was unrevealing, subsequent MRIs showed bilateral optic nerve enhancement and restricted diffusion as well as lesions within the brainstem and cerebral white matter. MRI of the spinal cord showed a high T2 signal lesion at the level of T9-T10.

Conclusions CONCLUSIONS: We describe the clinical presentation and diagnostic test results of a case of suspected cocaine and levamisole related complications. Clinicians should be aware not only of the potential vascular complications of cocaine use but of the potential complications associated with the adulterant levamisole.

Authors/Disclosures
Ruth Schneider, MD, FAAN (University of Rochester) PRESENTER	Dr. Schneider has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Escape Bio. The institution of Dr. Schneider has received research support from The Michael J. Fox Foundation. The institution of Dr. Schneider has received research support from NIH. The institution of Dr. Schneider has received research support from Acadia Pharmaceuticals. The institution of Dr. Schneider has received research support from CHDI. The institution of Dr. Schneider has received research support from Biohaven Pharmaceuticals. The institution of Dr. Schneider has received research support from Parkinson Study Group. The institution of Dr. Schneider has received research support from The Michael J. Fox Foundation. The institution of Dr. Schneider has received research support from Bial. Dr. Schneider has received personal compensation in the range of $500-$4,999 for serving as a Telemedicine Evaluator with Parkinson's Foundation.
Lawrence M. Samkoff, MD, FAAN (University of Rochester School of Medicine and Dentistry)	Dr. Samkoff has nothing to disclose.
Sharon Tamir	No disclosure on file

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