Abstract
Study designCase report.ObjectivesTo report a clinical case of spinal cord infarction due to cocaine use.SettingSpinal Center, IRCCS Fondazione S. Lucia, Rome (Italy).Case presentationTwo days after recreational use of cocaine, a 27-year-old Caucasic man was admitted to the emergency department for acute cervical pain, weakness in all four limbs, and urinary retention. A cervical spinal magnetic resonance imaging scan, performed after 2 days, showed a “pencil-like” lesion extending from C4 to T1 metamer, compatible with acute ischemia in the anterior spinal artery territory. Other causes of vascular disorders, as well as inflammatory and infectious disorders were ruled out. At admission in our department, the patient had an incomplete tetraplegia at level C6, an indwelling catheter, and was unable to stand and walk. After 3 months of rehabilitation, he had an AIS score D tetraplegia at level C7, was able to stand and walk using parallel bars, and indwelling catheter was replaced by intermittent catheterization.Discussion and conclusionsThe etiology of medullary infarction may remain unexplained in nearly 30–40% of cases. Even if rare, cocaine-induced ischemic myelopathy should be considered and ruled out in the differential diagnosis of any acute nontraumatic myelopathy, especially in young patients.
Highlights
The use of recreational drugs is a rising phenomenon, with an estimated prevalence of 5% in the global population aged 15–64 years [1].Cocaine is one of the most abused illicit drug, especially among young adults between the second and fourth decade of life, and is responsible for many neurologic complications
Cocaine abuse is well known to be associated with cerebrovascular events, but a few cases of cocaine-induced acute spinal cord ischemia (ASCIS) have been described [3,4,5,6,7,8]
All involved young adults, and in all of them the lesion was mainly located in the anterior spinal artery (ASA) territory of the cervical spinal cord [4,5,6, 8], except one case [7] involving T1–T4 levels and one case with involvement of the posterior spinal artery at cervical level (C2) [3]
Summary
To report a clinical case of spinal cord infarction due to cocaine use. Case presentation: Two days after recreational use of cocaine, a 27-year-old Caucasic man was admitted to the emergency department for acute cervical pain, weakness in all four limbs, and urinary retention. A cervical spinal magnetic resonance imaging scan, performed after 2 days, showed a “pencil-like” lesion extending from C4 to T1 metamer, compatible with acute ischemia in the anterior spinal artery territory. At admission in our department, the patient had an incomplete tetraplegia at level C6, an indwelling catheter, and was unable to stand and walk. After 3 months of rehabilitation, he had an AIS score D tetraplegia at level C7, was able to stand and walk using parallel bars, and indwelling catheter was replaced by intermittent catheterization
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