Cocaine-Induced Toxic Leukoencephalopathy: A Case Report

Area of Science:

• Neurology
• Toxicology
• Radiology

Background:

• Cocaine abuse is a significant public health concern.
• Neurological complications associated with cocaine use require further investigation.
• Distinguishing cocaine-induced leukoencephalopathy from other conditions like PRES is clinically important.

Observation:

• A 57-year-old male presented with altered mental status and was diagnosed with multifocal leukoencephalopathy.
• Brain MRI revealed characteristic white matter hyperintensities and diffusion restriction.
• Toxicological analysis confirmed cocaine use; levamisole, a common adulterant, was considered a potential neurotoxin.

Findings:

• Cocaine-induced neuronal toxicity was identified as the cause of the patient's leukoencephalopathy.
• The patient received a short course of methylprednisolone with gradual mental status improvement.
• Differential diagnoses, including autoimmune, vasculitic, and infectious etiologies, were systematically excluded.

Implications:

• This case highlights the critical need to consider cocaine-induced leukoencephalopathy in patients with unexplained neurological deficits.
• Investigating for levamisole in cocaine users with neurological symptoms is recommended.
• Further research is needed to elucidate the pathophysiology and establish treatment guidelines for cocaine-induced leukoencephalopathy.