A Case of Cocaine-induced Toxic Leukoencephalopathy With Severe Radiologic but Mild Clinical Disease

Abstract

Objective: To present a case of toxic leukoencephalopathy secondary to cocaine use presenting as mild clinical disease with mainly neurobehavioral symptoms, but relatively severe radiologic disease. Background: The term leukoencephalopathy was first used to describe cerebral white matter changes seen in children with leukemia, but is now used to refer to any of a group of diseases affecting the white substance of the brain. Toxic leukoencephalopathy may be caused by exposure to a wide variety of agents, including cranial irradiation, therapeutic agents, drugs of abuse and environmental toxins. Cocaine-induced toxic leukoencephalopathy is a relatively rare phenomenon with unknown prevalence. Case Presentation: We describe a case of cocaine-induced toxic leukoencephalopathy in a 55-year-old man presenting with confusion, inattention, abulia, and apathy. Infectious work-up and cerebrospinal fluid studies were unremarkable except for a mild elevation of cerebrospinal fluid protein. Magnetic resonance imaging of the brain showing extensive bilateral symmetric leukoencephalopathy is provided, along with a brief discussion of this entity of white matter disease. Conclusions: Cocaine use can manifest as diffuse symmetric white matter changes on magnetic resonance imaging of the brain as well as changes in the basal ganglia and globus pallidus. In the absence of other laboratory and historical abnormalities and in the setting of neurobehavioral disabilities and previous drugs use, it is important to consider cocaine-induced leukoencephalopathy as a differential.