Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

Cocaine is one of the most commonly abused recreational drugs, second only to marijuana. It blocks the reuptake of neurotransmitters such as norepinephrine and dopamine, that leads to persistent post-synaptic stimulation responsible for its excitatory effects. Cocaine-related strokes, both ischemic and hemorrhagic, have been well described in the literature and cerebral vasospasm is hypothesized as one of the major mechanisms responsible for the presentation. Although cases of posterior circulation infarction were previously reported, we herein report a rare presentation of a cocaine-induced bilateral posterior inferior cerebellar artery and hippocampal infarction in a middle-aged female.

Section: Discussionmentioning

confidence: 99%

Cocaine Induced Bilateral Posterior Inferior Cerebellar Artery and Hippocampal Infarction

Mullaguri

Battineni

Narayan

et al. 2018

“…The recovery of case 1 was likely limited by his continued drug use, age, and other vascular risk factors, whereas the recovery of case 2 was aided by his younger age and abstinence from further illicit drug use. Existing case reports of patients with bilateral ischemic hippocampal lesions in patients who abused cocaine note that most of the patients reported had persistent anterograde amnesia, with difficulty particularly in declarative and episodic memory [2][3][4][5][6][7][8]. In those patients, cognitive deficits persisted for weeks to months following the initial insult, and the duration of follow up in those patients was highly variable (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Vascular supply stems primarily from the collateral branches of the posterior cerebral artery (PCA) and the anterior choroidal artery [1]. In recent years, cases of patients developing anterograde amnesia with notable MRI abnormality of bilateral hippocampal ischemia in the setting of substance abuse, most notably with opioids and to a lesser extent cocaine, have been reported [2][3][4][5][6][7][8][9]. Bilateral hippocampal ischemia is a rare complication of cocaine abuse [3].…”

Section: Introductionmentioning

confidence: 99%

“…Bilateral hippocampal ischemia is a rare complication of cocaine abuse [3]. Most of the cases reported so far had a poor recovery, but the duration of patient follow-up was highly variable or unknown [2][3][4][5][6][7][8]. We report two consecutive cases with a history of consistent cocaine abuse, who presented with acute anterograde amnesia and had similar MRI findings of bilateral hippocampal ischemia but had different outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bilateral Acute Hippocampal Ischemia in Two Patients Abusing Cocaine: What is the Outcome?

Tsai¹,

O'Reggio²,

Mehrabyan³

et al. 2022

Hippocampal ischemia is a rare complication of cocaine abuse that has been thought to arise from vasospasm, anoxic injury, and/or catecholaminergic excitotoxicity. We present two cases of patients abusing cocaine, who presented with an acute onset anterograde amnesia due to bilateral hippocampal ischemia, and had different outcomes. Case 1 is a 49-year-old male with a history of IV heroin abuse who presented after being found down for an unknown period of time. He awoke with no memory of events leading up to hospitalization and was unable to retain new information. Urine toxicology was positive for cocaine and opiates. Traditional vascular risk factors included obesity, hypertension, and hyperlipidemia. His recovery was complicated by continued drug use and one episode of cardiac arrest. Despite cognitive rehabilitation, only minimal improvements in his anterograde memory were observed during his annual follow-up. Case 2 is a 23-year-old male with a history of attention deficit disorder treated with dexmethylphenidate and a history of consistent marijuana and cocaine abuse, who presented with nausea, vomiting, chest pain, shortness of breath, and acute-onset short-term memory loss. Urine toxicology was negative for cocaine and opiates and positive for marijuana. He had no known vascular risk factors. With cognitive rehabilitation and discontinuation of illicit drug use, he demonstrated a significant improvement in his memory function over the course of six months. Brain MRI in both patients showed symmetric bilateral hippocampal diffusion restriction without post-contrast enhancement with corresponding hyperintensities on fluid-attenuated inversion recovery sequences. In both patients, cerebrospinal fluid (CSF) studies were unremarkable for inflammation or infection, and electroencephalograms were normal in awake and drowsy states. Bilateral hippocampal ischemia should be considered as a potential cause of acute onset anterograde amnesia in patients with a history of cocaine abuse. Other substances such as heroin and dexmethylphenidate may potentially increase susceptibility for hippocampal ischemia in patients using cocaine. Discontinuation of illicit drug abuse can influence the degree of recovery from acute bilateral hippocampal ischemia.

“…Ischemia after cardiac arrest, for example, carries a low likelihood of memory recovery [ 2 ]. Cocaine-induced vasospasm and carbon monoxide poisoning are rare but well-recognized causes of bilateral hippocampal ischemia [ 13 , 14 ]. Case reports and a few case series in the literature suggest that patients with hypoxia but no evidence of ischemia, and those with histotoxic hypoxia such as that seen with carbon monoxide poisoning, may be more likely to recover regardless of initial imaging severity [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Complete Bilateral Hippocampal Diffusion Restriction and Reversible Amnesia Following Opiate, Cocaine, and Benzodiazepine Abuse

Huang

Lukas

2021

The hippocampus is a crucial component of the circuits involved in memory formation and recall. Bilateral hippocampal lesions can lead to profound anterograde amnesia. As a highly vascularized structure, the hippocampus is susceptible to ischemia from hypoxic and toxic insults. Infarction of bilateral hippocampi as a result of cocaine use, while rare, is well described in the literature. Combined opiate and stimulant abuse also cause dysfunction of this structure. We present a case of complete bilateral hippocampal diffusion restriction and anterograde amnesia after heroin, cocaine, and benzodiazepine abuse, consistent with opioid-associated amnestic syndrome, as well as a remarkable resolution of amnesia months later.