Bilateral basal ganglia lesions in patient with cocaine use

Background and Aims: Several studies have demonstrated the association between cerebrovascular disease and the use of cocaine and may cause a variety of complications such as stroke, vasculitis, seizures, cognitive impairment, subarachnoid haemorrhage, toxic encephalopathy. Two-thirds of deaths caused by drug overdose are opioid-related. Individuals with opioid use may present with a variety of complications. Methods: 52 years old male admitted with chest infection and multiple comorbidities, Covid-19 negative, known cocaine user, become confused, agitated and aggressive after 3th days. CT scan brain -negative MRI brain after 5 days of admission-bilateral basal ganglia hypodensity, interpreted as a neuro toxicity. Unfortunately patient left hospital against medical advice and readmitted after 3 days with worsening conditions. Results: The exact pathophysiology of basal ganglia injury in opioid users is not well understood. Various hypotheses have been proposed-hypoxic cerebral injury and direct neuronal toxicity Vasospasm induced by action on l-opioid receptors may result in cerebral ischemia. Also associated with myocardial infarction, vasoconstriction, uncontrolled hypertension. Conclusions: 1. Cocaine is associated with vascular toxicity. The physiopathological mechanisms involved in the production of ischemic cerebrovascular accidents are multiple and synergic, but vasoconstriction stand out among them 2. MRI brain -bilateral basal ganglia involvement is typical. (Table Presented).