Bilateral lesions of the globus pallidus in a young woman

Kadi, Redouane; Rumy, A.; Stadnik, Tadeusz; Cannie, Mieke; Mabiglia, Chiara; Divano, Luisa

doi:10.5334/jbr-btr.23

Cited by 5 publications

(4 citation statements)

References 6 publications

(11 reference statements)

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“…The description of patient one ( Table 1 ) suggests extrapyramidal features due to encephalitis with basal ganglia damage. In particular, bipallidal T2 hyperintense lesions have been described in a wide range of conditions, from cocaine use [ 41 ] to COVID-19 [ 42 , 43 ], and parkinsonism is a key clinical manifestation of this neuroimaging pattern [ 44 ]. The neuroradiological picture of patients two and five ( Table 1 ), with a similar clinical scenario, shows a different type of encephalitic involvement in COVID-19, namely acute necrotizing encephalopathy with acute bilateral thalamic lesions, a severe disease prevalent among children in East Asia, outside COVID-19 [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Parkinsonism: A Critical Appraisal

et al. 2022

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A few cases of parkinsonism linked to COVID-19 infection have been reported so far, raising the possibility of a post-viral parkinsonian syndrome. The objective of this review is to summarize the clinical, biological, and neuroimaging features of published cases describing COVID-19-related parkinsonism and to discuss the possible pathophysiological mechanisms. A comprehensive literature search was performed using NCBI’s PubMed database and standardized search terms. Thirteen cases of COVID-19-related parkinsonism were included (7 males; mean age: 51 years ± 14.51, range 31–73). Patients were classified based on the possible mechanisms of post-COVID-19 parkinsonism: extensive inflammation or hypoxic brain injury within the context of encephalopathy (n = 5); unmasking of underlying still non-symptomatic Parkinson’s Disease (PD) (n = 5), and structural and functional basal ganglia damage (n = 3). The various clinical scenarios show different outcomes and responses to dopaminergic treatment. Different mechanisms may play a role, including vascular damage, neuroinflammation, SARS-CoV-2 neuroinvasive potential, and the impact of SARS-CoV-2 on α-synuclein. Our results confirm that the appearance of parkinsonism during or immediately after COVID-19 infection represents a very rare event. Future long-term observational studies are needed to evaluate the possible role of SARS-CoV-2 infection as a trigger for the development of PD in the long term.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and Parkinsonism: A Critical Appraisal

et al. 2022

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“…There are prior cases of bilateral basal ganglia lesions in stimulant use. For example, there is a case of bilateral basal ganglia lesions following MDMA use [ 24 ] and an additional case involving methadone, cocaine, and amphetamines [ 25 ] producing basal ganglia lesions. A combination of cocaine and alcohol resulting in unconsciousness has also produced bilateral basal ganglia lesions [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations

Inciarte,

de la Mora,

Huaier-Arriazu

et al. 2024

Infect Dis Ther

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background A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the ‘chemsex’ context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization. Clinical finding After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl — elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1 . Conclusions The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-00962-x.

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“…Its presentation can fairly be like any stroke or todd's palsy while the diagnosis is made by brain imaging. High-intensity BGPL seen on diffusion-weighted and T2 images are diagnostic in the settings of appropriate history 8 . It is mostly seen with parenteral long-term heroin abuse possibly due to decreased neuronal population densities due to recurrent episodes of hypoxia secondary to suppression of respiratory center 9 , 10 .…”

Section: Discussionmentioning

confidence: 99%

Can inhaled heroin be a cause of bilateral globus pallidus ischemic injury?

Iqbal

Khan

Ullah

2019

Turkish Journal of Emergency Medicine

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Introduction Bilateral globus pallidus lesions have been characteristically thought to be associated with global cerebral hypoperfusion and hypoxic changes. One of the important causative factors that need to be considered is the opiate drug abuse. Case presentation We present a case of a 50-year-old male who came to the hospital after being found down for 3 hours. He was found to have weakness of right upper and lower extremity. MRI showed bilateral globus pallidus infarcts. He later admitted to inhalation of heroin. Over the next few days, weakness started to improve and he was eventually discharged to rehabilitation. This case is a unique presentation of bilateral globus pallidus lesions after a one-time inhalation of heroin. Conclusion We, therefore, advocate that inhaled heroin should be considered as one of the causes of bilateral globus pallidus lesions, in addition to IV heroin and cocaine and physicians should be aware of the possibility of alternate forms of heroin abuse in such patients.

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Bilateral lesions of the globus pallidus in a young woman

Cited by 5 publications

References 6 publications

COVID-19 and Parkinsonism: A Critical Appraisal

COVID-19 and Parkinsonism: A Critical Appraisal

Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations

Can inhaled heroin be a cause of bilateral globus pallidus ischemic injury?

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