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Toxic Leukoencephalopathy Presenting as Lethal Catatonia.

Anouk M J van Esch¹, Antine Fest, Britt S Hoffland

¹Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (AMJvE, AF, JGEJ, AFAS); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (BSH, RAJE); and Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands (SCAS).

Journal of Addiction Medicine

|November 6, 2018

Summary

This case report details a fatal case of catatonia resulting from delayed toxic leukoencephalopathy after cocaine and methadone use. Key findings include characteristic MRI scans and a biphasic clinical course in drug intoxication.

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Area of Science:

Neurology
Toxicology
Psychiatry

Background:

Catatonia is a complex syndrome associated with various psychiatric and somatic conditions.
Delayed toxic leukoencephalopathy is a rare but severe neurological complication of substance abuse.

Observation:

A 54-year-old woman presented with unconsciousness following cocaine and methadone intoxication.
Her condition progressed to lethal catatonia after an initial period of recovery.
Magnetic resonance imaging (MRI) revealed white matter abnormalities and diffusion restriction indicative of leukoencephalopathy.

Findings:

The case illustrates a biphasic course of delayed toxic leukoencephalopathy.
Specific MRI findings are crucial for diagnosing this condition.
Substance abuse, specifically with cocaine and methadone, can precipitate this severe neurological outcome.

Implications:

This case highlights the critical need to consider toxic leukoencephalopathy in patients with catatonia and a history of substance abuse.
Early recognition and characteristic MRI findings are vital for diagnosis.
Understanding the biphasic nature of this condition is important for patient management and prognosis.