Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

Abstract

<jats:p>With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or “snorting.” Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. Occasionally, cocaine-induced lesions cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate and can mimic other diseases such as tumors, infections, and immunological diseases. In the literature currently available, involvement of the craniovertebral junction in the cocaine-induced midline destructive lesions (CIMDLs) has never been reported.</jats:p> <jats:p>The present case concerns a 44-year-old man who presented with long-standing symptoms including nasal obstruction, epistaxis, dysphagia, nasal reflux, and severe neck pain. A diagnosis of CIMDL was made in light of the patient’s history and the findings on physical and endoscopic examinations, imaging studies, and laboratory testing. Involvement of the craniovertebral junction in the destructive process was evident. For neurosurgical treatment, the authors considered the high grade of atlantoaxial instability, the poorly understood cocaine-induced lesions of the spine and their potential evolution overtime, as well as cocaine abusers’ poor compliance. The patient underwent posterior craniovertebral fixation. Understanding, classifying, and treating cocaine-induced lesions involving the craniovertebral junction are a challenge.</jats:p>

How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology

“…These destructive lesions are primarily located in the vomer, in the palate (palatine bones) and inferior nasal conchae; with other bones affected being the ethmoid, maxillary sinuses, sphenoid and orbit [18]. One clinical case showed also an extension of CIMDL into the neck area, especially with some destruction and instability of the atlanto-axial joint [39].…”

Infective complications of midline destruction in a cocaine user

“…Intranasal cocaine abuse is known to cause erosion of the palate and destruction of the mucosa 1. Various mechanisms are postulated such as local vasoconstriction causing ischaemia, chemical irritation, trauma causing infection, impaired immunity and abnormal mucociliary transport 2 3…”