Unusual complication of cocaine abuse. [Neuroradiology] [MR]
Unusual complication of cocaine abuse. [Neuroradiology] [MR]
Patient was a young adult working in finance at a major tech company found to be mute and diaphoretic.
Physical exam notable for fever, tachycardiac, hypertension, awake but not following commands, aphasic, and with hyperreflexia and muscle ridigity. CK peaked to 11,344.
MRI shows multiple ovoid to splotchy confluent lesions in the white matter with diffusion restriction. Lesions also enhanced with hyperperfusion (not shown).
Urine drug test positive for cocaine. Infectious work-up was negative. Steroids were started with good recovery.
Patient denied knowingly taking cocaine but did say weekly use of what they thought was MDMA with friends...
Final diagnosis: Levamisole-induced leukoencephalopathy. Levamisole is an antiparasite medication that is no longer used in the US but still in some other countries. It is a common cutting agent in cocaine. It's neurotoxic effects primarily come from causing demyelination.
Can you provide some meta context here? The title is like your a friend but the text is from a medical professional.
I am just hoping you have consent to post such private info is what i mean.
Thank you for this comment, because it brings up some very important issues, which I hope this reply addresses.
The biggest issue is the matter of patient confidentiality. This is of utmost concern in an online medical community, especially one wherein clinical vignettes are presented. I take extreme care to avoid including any information that can narrow down to a patient, thus breaching confidentiality. Similarly, I expect anyone else commenting or posting here to follow this rule, Rule 4, which was created not just for internet etiquette but literally to prevent illegal breaches of confidentiality. With regards to consent - this is not required for publishing de-identified information, or sites like Radiopaedia with their thousands of cases would not exist. With regards to patient confidential information that cannot be shared - this not only includes the obvious ones such as patient age, DOB, dates of events, addresses, etc etc, but also vaguer information. For example, there are cases that I would never present here online because the disease is so incredibly rare that the disease itself becomes a patient identifier. These types of cases I would formally publish in the literature if need be. For this particular case, I do not think the information presented breaks these rules (or I would not have posted). Cocaine use is fairly common among the demographic in question, and being found in the shower is not that uncommon, although dramatic.
Second, to address the following:
The title is like your a friend but the text is from a medical professional.
This is something that I have been struggling with. This community is growing at an exceptional rate, and visitors seem to be overwhelmingly from a non-medical background. There are comments that frankly say they do not understand certain things, and other comments and questions imply a lack of experience with looking at imaging studies. I have been vacillating between using terminology and sentences that laypeople can understand versus maintaining medical terminology. I think this is why you think I am writing about a friend in the title, but the body of the post is more medically-oriented. For this reason, I have changed the title - it did not need to be so dramatic. In the future, I will be more careful with my wording.
Please let me know if this addresses your concerns. I would also love to hear more input regarding point #2. Should I continue to word cases as if talking to other medical professionals or include more basic terminology so that the general public can understand? The purpose of these cases, and this community in general, is to be an educational resource in terms of what Radiology is and does.
As a lat person with medical curiosities, I am here for the medical jargon, things i don't understand I am more than willing to do extra research.
Especially since this field doesn't lend itself hobbies radiologists, don't worry about us spectators. Outside of informing of HIPPA rules and violations.
Honestly, start with HIPPA (unsure of EU or other country medical laws for privacy) first, and as the community grows so will the spectators Cheers
Actually i think its quite refreshing to see some actual scientific terminology and many laymen questions could easily be answered in the comments rather then adapting the post to visitors.
On point 2. It may have been my bad, i think i misread “my roommate” sorry for misunderstanding.
I think the sincerity is proof enough that your willing to follow and respect the patiënt and privacy laws. I fully agree that the text is not very identifying.
I have however grown increasingly aware of traceability on the web and how much easiers computers can detect obscure identifiers almost invisible to humans.
One of the things that worry me is how identifying currently non identifying pictures can be. Bodies are unique both out and inside, for all we know we can reconstruct the shape of ones head and face with just a few of these in just a few years.
I feel rather conflicted about it because on one side i am all for the free flow and sharing of scientific information because the more accessible learning new things becomes the better of we will all be. On the other if i learned my dr posted a picture of just my toe nail online for any reason but without asking me. I’d feel rather violated.
What definitely accelerated my worry here was my misunderstanding on your relation with the patient because what i have seen before is people who are not online becoming identifiable over time as a “friend/acquaintance/other” simply mentiones innocent things like “went to dinner with x last night” and in a picture a menu is shown with the name of a local restaurant.
May look far fetched and i admit i am personally maybe a bit overly aware of these risks. But people can be real creeps and so are data harvesting companies.
[The person whose brain you are looking at was] found by [his or her] roomate in the shower, mute and diaphretic, after missing work.
There's no real private information here. Young adult working with finance testing positive for cocaine? Sure, that narrows it down. If medical professionals weren't allowed to talk about their experiences even when anonymized we would still be in the middle ages in terms of medicine.
What are the expected long-term effects, if any? Given the adult brain's capability of remyelination, and the fact that this is a young adult, is full recovery possible?
It said in there that it was a good recovery, which for being bilateral lesions affecting a large portion of their brain, is pretty freaking lucky. I would have expected very little recovery and a lifetime of disability. I'm a pessimist when I see this stuff though, too many bad cases in the past.
This complication of cocaine use generally manifests as a single episode of demyelination that recovers well with treatment. Of course, the long term depends on how often the cocaine abuse happens.
Love your posts. Keep it up please.