Cocaine
Bump on 4chan has nothing to do with cocaine, but that's not what one news report said. Getty Images

Cocaine is one of the most commonly abused drugs in the United States and the second most popular recreational drug after marijuana. It is also recognized to be a contributing factor for both ischemic and hemorrhagic strokes.

According to a recent case report published in the Journal of Medical Case Reports, a 51-year-old African American woman developed ‘Locked-in syndrome’ after inhaling cocaine.

What is ‘Locked-in Syndrome’ (LIS)?

It is a rare symptom of stroke which is highly challenging for doctors to diagnose since it takes at least 78 days to uncover. Diagnosis of LIS requires a combination of physical examination abnormalities as well as findings based on neuroimaging via MRI scans. The syndrome is characterized by the following:

  • Paralysis of legs, hands, and mouth
  • Cranial nerve deficits
  • Consciousness being intact with cognitive function and
  • Vertical eye movement

The patient was rushed to the hospital’s emergency department for acute behavior changes. During admission, she had a dramatic decrease in motor strength in all her limbs. Her boyfriend said that she was seen inhaling cocaine the previous night. Her family members reported that she had maternal chronic kidney disease, diabetes mellitus, hypertension, was unemployed, used tobacco and also abused substances like heroin and cocaine.

Upon initial examination, they found her to be an awake, alert and obese African-American woman who was confused, agitated and unable to follow commands. Her urine toxicology reported positive for cocaine, opiates, and benzodiazepines. Her head CT scan was negative for any acute changes.

Her presentation was consistent with classic LIS since she was able to communicate with vertical eye movements but was completely immobile. She was treated with empirical intravenous vancomycin, cefepime, etomidate, and rocuronium and was later placed on tracheostomy and a percutaneous tube. Supportive care with rehabilitation was then initiated. While her mental status improved, she was only able to communicate via movements of her eyes. After a couple of weeks, she died of suspected aspiration.

By far, only very few cases have been reported describing cocaine as the potential cause for LIS. Also, the mechanism in which the substance induces a stroke is not yet completely understood.

“We suggest that the usual clinical manifestations of LIS can result from cocaine use and, importantly, that cocaine use should be included among the potential causes of LIS. A routine investigation by obtaining a urine toxicology screen for all patients with altered mental status is very important and everyone should be aware of the serious complications of cocaine use,” said the lead author of the case report Osman Ali.

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