Neurological and systemic effects of cocaine toxicity: A case report and review of the literature

Hong,Zachary M.; Kromm,Julie A.

doi:10.3892/mi.2024.196

Neurological and systemic effects of cocaine toxicity: A case report and review of the literature

Authors:
- Zachary M. Hong
- Julie A. Kromm
View Affiliations

Affiliations: Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada, Department of Critical Care Medicine, Cumming School of Medicine, Foothills Medical Centre, McCaig Tower, Calgary, AB T2N 5A1, Canada
Published online on: October 8, 2024 https://doi.org/10.3892/mi.2024.196
Article Number: 72
Copyright : © Hong et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

While historically utilized as a topical anesthetic and active ingredient in a variety of tonics, beverages and cure‑alls, cocaine is a commonly abused illicit substance. Cocaine use is associated with a variety of neurological and systemic complications. The present study describes the case of a 23‑year‑old female patient presenting with profound neurological and systemic complications of cocaine, including coma, leukoencephaloapthy, neurogenic stunned myocardium, transaminitis, acute kidney injury, rhabdomyolysis and mononeuropathy. The supportive management and subsequent outcomes of the patients are discussed in detail. The approach to coma is also discussed, including stabilization and supportive care, diagnostic considerations and management. Key considerations relating prognosticating disorders of consciousness are also highlighted.

View Figures

View References

1	Middleton RM and Kirkpatrick MB: Clinical use of cocaine. A review of the risks and benefits. Drug Saf. 9:212–217. 1993.PubMed/NCBI View Article : Google Scholar
2	Annual Reports Questionnaire: Annual prevalence of drug use: Amphetamines (Internet). https://public.tableau.com/views/Prevalence-general/Prevalence-general-heatmap?:showVizHome=no. Accessed August 23, 2024.
3	Rajajee V, Riggs B and Seder DB: Emergency neurological life support: Airway, ventilation, and sedation. Neurocrit Care. 27 (Suppl 1):S4–S28. 2017.PubMed/NCBI View Article : Google Scholar
4	Stocchetti N, Taccone FS, Citerio G, Pepe PE, Le Roux PD, Oddo M, Polderman KH, Stevens RD, Barsan W, Maas AI, et al: Neuroprotection in acute brain injury: An up-to-date review. Crit Care. 19(186)2015.PubMed/NCBI View Article : Google Scholar
5	Vosoughi R and Schmidt BJ: Multifocal leukoencephalopathy in cocaine users: A report of two cases and review of the literature. BMC Neurol. 15(208)2015.PubMed/NCBI View Article : Google Scholar
6	Brewer JD, Meves A, Bostwick JM, Hamacher KL and Pittelkow MR: Cocaine abuse: Dermatologic manifestations and therapeutic approaches. J Am Acad Dermatol. 59:483–487. 2008.PubMed/NCBI View Article : Google Scholar
7	Núñez MJ, Balboa J, Rey-Méndez M, Brenlla J, González-Peteiro M, Rodrigo E and Freire-Garabal M: Effects of amphetamine and cocaine on the development of acute experimental allergic encephalomyelitis in Lewis rats. Hum Exp Toxicol. 26:637–643. 2007.PubMed/NCBI View Article : Google Scholar
8	Richards JR and Le JK: Cocaine toxicity. In: StatPearls. StatPearls Publishing, Treasure Island, FL, 2024. https://www.ncbi.nlm.nih.gov/books/NBK430976/. Updated June 8, 2023.
9	Farooque U, Okorie N, Kataria S, Shah SF and Bollampally VC: Cocaine-induced headache: A review of pathogenesis, presentation, diagnosis, and management. Cureus. 12(e10128)2020.PubMed/NCBI View Article : Google Scholar
10	Kondziella D, Danielsen ER and Arlien-Soeborg P: Fatal encephalopathy after an isolated overdose of cocaine. J Neurol Neurosurg Psychiatry. 78:437–438. 2007.PubMed/NCBI View Article : Google Scholar
11	Vitt JR, Brown EG, Chow DS and Josephson SA: Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user. J Neuroimmunol. 305:128–130. 2017.PubMed/NCBI View Article : Google Scholar
12	Cisneros O, Garcia de de Jesus K, Then EO and Rehmani R: Bilateral basal ganglia infarction after intranasal use of cocaine: A case report. Cureus. 11(e4405)2019.PubMed/NCBI View Article : Google Scholar
13	Renard D, Brunel H and Gaillard N: Bilateral haemorrhagic infarction of the globus pallidus after cocaine and alcohol intoxication. Acta Neurol Belg. 109:159–161. 2009.PubMed/NCBI
14	Schwartz BG, Rezkalla S and Kloner RA: Cardiovascular effects of cocaine. Circulation. 122:2558–2569. 2010.PubMed/NCBI View Article : Google Scholar
15	Glauser J and Queen JR: An overview of non-cardiac cocaine toxicity. J Emerg Med. 32:181–186. 2007.PubMed/NCBI View Article : Google Scholar
16	de Souza A, Desai PK and de Souza RJ: Acute multifocal neuropathy following cocaine inhalation. J Clin Neurosci. 36:134–136. 2017.PubMed/NCBI View Article : Google Scholar
17	Beniczky S, Tfelt-Hansen P, Fabricius M and Andersen KV: Multiple mononeuropathy following cocaine abuse. BMJ Case Rep. 2009(bcr07.2008.0446)2009.PubMed/NCBI View Article : Google Scholar
18	Gallelli L, Gratteri S, Siniscalchi A, Cione E, Sirico S, Seminara P, Caroleo MC and De Sarro G: Drug-drug interactions in cocaine-users and their clinical implications. Curr Drug Abuse Rev. 10:25–30. 2017.PubMed/NCBI View Article : Google Scholar
19	Wilson T, Pitcher I and Bach P: Avoidance of β-blockers in patients who use stimulants is not supported by good evidence. CMAJ. 194:E127–E128. 2022.PubMed/NCBI View Article : Google Scholar
20	Rohaut B, Eliseyev A and Claassen J: Uncovering consciousness in unresponsive ICU patients: Technical, medical and ethical considerations. Crit Care. 23(78)2019.PubMed/NCBI View Article : Google Scholar
21	Wijdicks EFM: Predicting the outcome of a comatose patient at the bedside. Pract Neurol. 20:26–33. 2020.PubMed/NCBI View Article : Google Scholar
22	Wijdicks EFM and Hwang DY: Predicting coma trajectories: The impact of bias and noise on shared decisions. Neurocritical Care. 35:291–296. 2021.PubMed/NCBI View Article : Google Scholar