我们在这里介绍一个病例,一名57岁的南亚男性精神状态紊乱,发展为多灶性白质脑病,我们认为这是由可卡因的使用引起的.在尿液毒理学样品中检测到可卡因。非急性CT头颅,随访脑MRI显示T2FLAIR信号的高强度对应于整个幕上白质的弥散限制,涉及枕叶以及后额叶和顶叶中央的半卵和皮质下U纤维。患者患有可逆性后部脑病综合征(PRES)的可能性较小,这可能在临床和影像学背景下表现类似,因为在就诊时或患者住院期间没有血压突然升高。进行了广泛的检查,以排除可能导致患者外观的其他因素。包括自身免疫,血管炎,和传染病。左旋咪唑,一种重要的化学物质,经常用于增加可卡因样品的体积,并与神经元损伤有关,应该在使用可卡因并表现出这些临床症状的个体中进行检查。在确定可卡因诱导的神经元毒性是其症状的原因后,该患者每天两次服用250mg甲基强的松龙,持续五天。虽然没有立即看到改善,在接下来的几天里,他确实表现出了一个渐进的,虽然轻微,他住在疗养院时精神状态的改善。了解可卡因使用之间的可能联系至关重要,一种经常被滥用的药物,和表现出类似临床症状的人。为了更好地了解病理生理学和可能的治疗方法,由于目前尚无推荐的治疗方案,因此需要进行更多的研究.
We present a case here where a 57-year-old South Asian male with disturbed mental status developed multifocal leukoencephalopathy, which we believe was caused by cocaine usage. Cocaine was detected in the urine toxicological sample. Non-acute CT head, with a follow-up brain MRI demonstrating hyperintensity of the T2 FLAIR signal corresponding to diffusion restriction throughout the whole supratentorial white matter, involving semiovale and subcortical U fibres in the occipital lobes as well as posterior frontal and parietal centrum. It was less likely that the patient had posterior reversible encephalopathy syndrome (PRES), which can potentially manifest similarly in a clinical and imaging context because there was no abrupt rise of blood pressure at presentation or during the patient\'s stay. Extensive examinations were conducted to exclude additional factors that may contribute to the patient\'s appearance, including autoimmune, vasculitis, and infectious diseases. Levamisole, a significant chemical that is frequently used to increase the volume of cocaine samples and has been linked to neuronal damage, should be examined in individuals who use cocaine and exhibit these kinds of clinical symptoms. The patient was prescribed 250 mg of methylprednisolone twice daily for five days after it was determined that cocaine-induced neuronal toxicity was the cause of his symptoms. Although no improvement was seen right away, over the course of the next few days, he did exhibit a gradual, albeit slight, improvement in his mental status while residing in the nursing home. It is crucial to comprehend the possible connection between cocaine usage, a commonly abused drug, and people exhibiting similar clinical symptoms. To have a better understanding of the pathophysiology and possible treatment approach, more research is necessary as there is now no recommended therapy regimen.