IMAGES IN MEDICINE
Cocaine-induced spinal cord infarction
1 Neurology Department, Frenchay Hospital, Bristol, UK
2 Internal Medicine, Bangor General Hospital, North, Wales, UK
Correspondence to:
Dr O Jumma, Neurology Department, Salford Royal Hospital, Stott Lane, Manchester M6 8HD, UK; odaijumma@yahoo.co.uk
Keywords: cocaine; hypertensive encephalomyelopathy; infarction; myelopathy; spinal cord
| The first 150 words of the full text of this article appear below. |
A 24-year-old man was transferred to the accident and emergency department with generalised seizures. He complained of headache, blurred vision and low backache after recreational cocaine use over the preceding few days. His condition deteriorated rapidly. He developed bilateral leg weakness, and his urine output had tailed-off. His blood pressure was 240/130 mm Hg. Clinical examination revealed global lower limb weakness (4 out of 5), with spastic tone bilaterally. His knee and ankle joint reflexes were exaggerated bilaterally, and he presented ankle clonus and extensor plantar responses. He also had bilateral impairment of pin prick and temperature sensation up to T12 level. His gait was ataxic and he was unable to perform the heel-to-toe test. He had bilateral papilloedema.
An urgent CT scan of his brain showed no intracerebral bleeding or space-occupying lesion. As he had a blood urea concentration of 23 mmol/l and a serum creatinine concentration of 742
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