Abstract TP207: Clinicoradiologic Discordance in Methamphetamine Vasculopathy-Associated Rhombencephalitis: Three New Cases of Temporal and Geographical Similarity

Abstract

Introduction: Structural and functional imaging techniques have demonstrated CNS abnormalities due to methamphetamine use, however there are no prior reports of rhombencephalon involvement. Furthermore, clinicoradiologic discordance is unique to this case series. Methods: We report a case series of patients with a diagnosis of vasculopathy-associated rhombencephalitis out of proportion to clinical examination in the setting of methamphetamine use at our tertiary stroke center. Results: Three patients were evaluated within 3 months of each other for focal neurologic deficits with normal mental status at our tertiary stroke center. All admitted to recent methamphetamine use. MRI of the brain with and without contrast demonstrated T2 hyperintensity without enhancement or diffusion restriction involving primarily the pons, consistent with vasogenic edema or demyelination (Figure 1). Workup for infectious and inflammatory etiologies including CSF analysis was unremarkable. All patients had vessel imaging demonstrating extracranial vasculopathy; all had dissections of the vertebral arteries, one of which had an associated pseudoaneurysm (Figure 1). All of the patients had GCS of 15 and minimal to no improvement with various treatment. Conclusion: Vasculopathy-associated rhombencephalitis in the setting of acute methamphetamine use has not been reported previously. The temporal and geographic relationship among these cases is key to the suspected diagnosis that a methamphetamine adulterant has a leukotoxinogenic predilection for the rhombencephalon. The cause of significant clinicoradiologic discordance remains unclear. Further investigation into this association is needed.