Bilateral hippocampal stroke secondary to acute cocaine intoxication

Abstract

Hippocampal infarction is a rare complication of cocaine use, with only two cases previously reporting this association. We present a 44-year-old male who developed a persistent amnesic syndrome following cocaine intoxication. Examination identified no other neurological deficits. Subsequent MRI brain revealed high FLAIR signals and diffusion restriction in the hippocampus and centrum semiovale bilaterally, consistent with infarction. These findings were in keeping with the results of formal neuropsychological testing where deficits in both verbal and visual episodic memory and learning capacity were identified, consistent with hippocampal dysfunction. In contrast to previous reports, this presentation occurred in the absence of other vascular risk factors or hypoxic insults.

Bilateral Hippocampal Restricted Diffusion: Same Picture Many Causes

“…These events represent presumed hypoxemia since we do not have documentation of hypoxemia during the drug overdose events in the outpatient setting. Four of the 8 patients also had concurrent use of cocaine, which has been associated in case reports with bilateral hippocampal infarction . Because these episodes were all associated with drug use, we cannot exclude the possibility that the drug itself had a toxic effect on the hippocampus.…”

“…Four of the 8 patients also had concurrent use of cocaine, which has been associated in case reports with bilateral hippocampal infarction. 11 Because these episodes were all associated with drug use, we cannot exclude the possibility that the drug itself had a toxic effect on the hippocampus. However, the fact that similar imaging findings occurred after alcohol and cocaine use as after opioid use decreases the likelihood that the imaging findings are direct toxic effects of a particular drug.…”

“…Axial DWI and T2-FLAIR MRI findings in patients with hypoxic injury (cases 1-8), hypoxic-ischemic injury (cases 9-10), seizures (cases[11][12][13], and other conditions (cases[14][15][16]. The finding of bilateral hippocampal DWI hyperintensity without significant accompanying edema is seen in all cases (column 1).…”

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

“…More commonly, bilateral lesions of the hippocampus occur from anoxia as the CA1 neurons are particularly vulnerable ( 5 ). In addition, bilateral lesions of the hippocampus have occurred in the context of cocaine use as the result of vasospasm without anoxia ( 6 , 7 ). We are aware of two cases of bilateral involvement of the hippocampus and bilateral involvement of the basal ganglia in anoxia and stimulant use.…”

Cluster of an Unusual Amnestic Syndrome — Massachusetts, 2012–2016

“…No readily apparent evidence for another established etiology of hippocampal amnesia ( 7 , 8 ) existed for any of the patients. Several previous isolated case reports were associated with cocaine use only ( 2 – 4 ), and one case of complete unilateral hippocampal infarction involving heroin inhalation was reported in France in 2013 ( 9 ).…”