A rare case in Turkey: Cocaine-induced multifocal leukoencephalopathy

Abstract

Use of cocaine can cause neorologic disorders such as hemorrhagic and ischemic cerebrovascular disease, seizure, neuropsychiatric complications, movement disorders, cerebral vasculitis, reversible cerebral vasoconstriction syndrome and multifocal leukoencephatopathy. Among them, multifocal inflammatory leukoencephatopathy occurs rarely and is found to be related with cocaine adulterant, levamisole. In this report, the case of cocaine/levamisole related multifocal inflammatory leukoencephatopaty appearing with clinical features of catatonia is presented. Female patient, 34 years of age, was evaluated with the complaints of loss of contact and abnormal behaviour at the emergency service. She was living in Austria and used cocaine three weeks before admission to hospital. Neurological examination revealed increased speech latency, echolalia and poor cooperation. Cranial MRI showed bilateral FLAIR and T2 hyperintense round-oval shaped lesions with patchy restricted diffusion and heterogenous contrast enhancement in subcortical periventricular white matter. Cranial imaging findings mimic demyelinating diseases in this case. Probable use of levamisole adulterated cocaine, by enhancing immune response, caused to come to a conclusion of levamisole related multifocal leukoencephalopathy. The patient has been started pulse metylprednisolon treatment. At the request of the patient, on the day sixth day of the treatment she transferred for abroad and further follow-up couldn' t be made. It is known that after use of levamisole, either for medical purpose or as illegal substance, by means of complex immune mechanisms it triggers multifocal leukoencephalopathy. Clinical presentation, radiological impression and histological findings of this condition is compatible with demyelinating diseases. Given the increased incidence of cocaine with its most common adulterant levamisole use, recognition and clinical management of its neurological complications is crucial.