Medullary carcinoma of the thyroid is an uncommon tumour. In most patients, it is confined to the neck with or without involvement of the local cervical nodes. It rarely metastasizes to the mediastinum, lungs or liver. Intracranial metastasis is extremely rare with very few reported cases in the literature. We report an unusual case of an intracranial metastasis from a medullary carcinoma of the thyroid that occurred 25 years after primary surgery. We discuss the unusual features of our case together with a review of the literature.

Cocaine is a well-known recreational drug with stimulant effects associated with relevant social, economic, and clinical implications. The most common route of abuse is via snorting. It has high addictive potential. Furthermore, one of the most well-known symptoms of a chronic user is chronic rhinitis. In the medical journals, there are numerous reports of complications, including lesions affecting the nasal septum, nasal sinuses, and even brain abscesses. We came across a 41-year-old male patient with severe manifestations of chronic cocaine use involving nasal, paranasal, and visual symptoms and signs. However, the most devastating was the complication of pituitary abscess, as a sequela to chronic cocaine sniffing. This case highlights the clinical, diagnostic, and management challenges with a multi-disciplinary approach. Last but not least, was the role of patient counselling and education. This ensured compliance towards management with a favourable outcome, which was rewarding for both the patient and the medical team involved in the care of the patient. It would hopefully create more awareness and assist in abstinence. We also hope it would incite more effort towards data collection and analysis, as well as allow us to explore the actual incidence of its use and devastating complications, which to date, for reasons of disguise and denial, remain somewhat ambiguous.