Cocaine Induced Bilateral Posterior Inferior Cerebellar Artery and Hippocampal Infarction

Abstract

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.

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

“…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).…”

“…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). However, it is unknown in these cases whether the patients discontinued illicit substance use [2][3][4][5][6][7][8][9]. Huang and Lukas (2021) reported a case of a 30-year-old male patient who presented with acute anterograde amnesia and bilateral acute hippocampal ischemia, who showed no improvement at one month, but improved to his baseline 10 months after the initial insult [9].…”

“…Although bilateral hippocampal ischemic lesions have been reported in association with mixed substance abuse, the exact incidence is unknown as it is still considered a rare complication with a poorly understood mechanism. Proposed mechanisms in the literature include anoxia, vasospasm, or catecholaminergic excitotoxicity [ 2 - 5 ]. One case of bilateral hippocampal ischemia reported in the literature occurred after an episode of myocardial infarction and suspected anoxia secondary to use of mixed opiate, cocaine, and stimulant use; however, in this case, there were concomitant bilateral basal ganglia lesions [ 2 ].…”

“…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].…”

“…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.…”