Radiology of Recreational Drug Abuse

Hagan, Ian; Burney, Kashif

doi:10.1148/rg.274065103

Cited by 81 publications

(88 citation statements)

References 59 publications

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“…Massive brainstem infarction has a sudden onset and patients are comatose at presentation 4. The involvement of the cervical cord is exceedingly rare, and to our knowledge only two cases have been reported in the literature; one of the patients had cocaine-induced malignant hypertension 512. Thus, our patient had a very rare neuroimaging manifestation of PRES, namely the involvement of cervical cord as well as medulla, and was initially reported as ADEM; this was not consistent with the clinical features (the patient had no history of fever/motor or sensory deficit to suggest myelopathy, either historically or on examination).…”

Section: Discussionmentioning

confidence: 99%

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Choh

Jehangir

Rasheed

et al. 2011

Annals of Saudi Medicine

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The posterior reversible encephalopathy syndrome (PRES) is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord (apart from the typical parieto-occipital lesions)-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome.

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Section: Discussionmentioning

confidence: 99%

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Choh

Jehangir

Rasheed

et al. 2011

Annals of Saudi Medicine

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“…5 Kokain kullanımına bağlı gelişen serebrovasküler problemler; kokain kullanımının neden olduğu davranışsal etkiler ile meydana gelen, kaza ya da kaza dışı nedenlerden kaynaklanan kraniyal travmaların yanı sıra, intrakraniyal hemoraji (İKH), iskemik strok, serebral vaskülit, PRES, serebral ödem, serebral atrofi ve merkezi sinir sistemi (MSS) enfeksiyonu gibi geniş bir spektruma hâkim nöro-lojik komplikasyonları içermektedir. 6 Bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MRG) ve konvansiyonel anjiyografi gibi tanısal görüntüleme yöntemlerinin, kokaine bağlı gelişen nörolojik komplikasyonların saptanmasında potansiyel olarak önemli bir rol oynayabileceği düşünül-mektedir.…”

Section: Kokain Kullanımına Bağlı Gelişenunclassified

“…33 Bu durum, yük-sek kan basıncı etkisi altındaki MSS'de serebral hiperperfüzyon, kan-beyin bariyerinin bozulması ve vazojenik ödem ile sonuçlanan serebrovasküler otoregülasyonun gerçekleşmemesinden kaynaklanmaktadır. 34 Ödem genellikle ilerleyen dönemde tamamen kaybolur.…”

Section: Posteri̇or Reversi̇bl Ensefalopati̇ Sendromuunclassified

“…Daha az sıklıkla bazal ganglionlar ve beyin sapını da tutabilir. 33 PRES'in MRG bulguları posterior pariyetal ve oksipital lobu etkileyen nispeten yamalı tarzda, simetrik ve reversibl T2 hiperintensiteleri şeklindedir. 36 BT bulguları ise aynı lokalizasyonlarda yamalı tarzda, simetrik, silik sınırlı hipodens alanlar şeklindedir.…”

Section: Posteri̇or Reversi̇bl Ensefalopati̇ Sendromuunclassified

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Neurological Complications of Cocaine Abuse: Updated Review of Radiologic Findings

Şafak¹

2015

Turkiye Klinikleri J Neur

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“…2,3 Only 1 patient with PRES was reported to have medulla oblongata, upper cervical spinal cord, and supratentorial involvement. 4 Herein we report 2 cases of a presumed variant of PRES with only medulla oblongata involvement.…”

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confidence: 98%

MR Imaging Findings of Medulla Oblongata Involvement in Posterior Reversible Encephalopathy Syndrome Secondary to Hypertension

Chen¹,

Lee²,

Wu³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:Although the combination of MR imaging findings and clinical evidence of hypertension may suggest the diagnosis of posterior reversible encephalopathy syndrome (PRES), MR imaging findings with only involvement of the medulla oblongata pose a diagnostic dilemma. In the cases presented here, we demonstrated MR imaging findings of a presumed brain stem (medulla oblongata) variant of PRES and emphasized the diagnostic value of diffusion-weighted imaging (DWI). Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, vomiting, altered consciousness, seizure, and cortical blindness associated with imaging findings of predominantly posterior bilateral symmetric subcortical and cortical edema without frank infarction.1 Hyperintense lesions on T2-weighted MR imaging and swelling of the brain stem may be related to many different pathologic processes. PRES rarely presents with predominant involvement of the brain stem, and involvement of only the medulla oblongata is uncommon.2,3 Only 1 patient with PRES was reported to have medulla oblongata, upper cervical spinal cord, and supratentorial involvement. 4 Herein we report 2 cases of a presumed variant of PRES with only medulla oblongata involvement. Case Reports Case 1A 59-year-old man with history of left putaminal hemorrhage 15 years previously had a 1-week history of poor appetite, vomiting, altered consciousness, and seizure-like movements. His history was also significant for hypertension controlled with medications. Initial blood pressure (BP) was 210/108 mm Hg. Serum electrolytes were normal. Brain MR imaging (Signa LX2; GE Healthcare, Milwaukee, Wis) revealed isointensity on T1-weighted images (T1WIs) and diffusionweighted images (DWIs), and hyperintensity on T2-weighted images (T2WIs) of the medulla oblongata and upper cervical spinal cord (Fig 1). Because of clinical signs and history and MR imaging findings of edema (not infarction) in the medulla oblongata and upper cervical spinal cord, the differential diagnosis included a variant of PRES, encephalitis, and encephalomyelitis. Because there was no evidence of infection or fever, and results on CSF examination were unremarkable, a variant of PRES was the likely diagnosis. An angiotensinconverting enzyme inhibitor and a calcium channel blocker were administered for BP control. His clinical condition improved, BP normalized to 140/90 mm Hg, and level of consciousness returned to normal. MR imaging 45 days later (Fig 1) indicated resolution of hyperintensity confirming a variant of PRES secondary to hypertension with involvement of the medulla oblongata. Case 2A 62-year-old man with a history of hypertension and cerebral infarction was seen with a 3-day history of headache, vomiting, involuntary movement, and change in consciousness. BP was 180/100 mm Hg. No signs of infection or a meningeal abnormality were present, and serum electrolyte levels and CSF were normal. Brain MR imaging showed hyperintensity on T2WIs and isointensity on DWIs, which involved the medulla oblongata (Fig ...

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Radiology of Recreational Drug Abuse

Cited by 81 publications

References 59 publications

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Neurological Complications of Cocaine Abuse: Updated Review of Radiologic Findings

MR Imaging Findings of Medulla Oblongata Involvement in Posterior Reversible Encephalopathy Syndrome Secondary to Hypertension

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