{"title":"Sniffed levamisole-adulterated cocaine mimicking acute demyelinating encephalomyelitis.","authors":"Joshua Yap, Kayla Ward, Simon Broadley","doi":"10.1136/pn-2024-004343","DOIUrl":null,"url":null,"abstract":"<p><p>A 38-year-old man developed headache, dysarthria and dysphasia after insufflation of cocaine. Brain imaging showed multiple white matter lesions, suggesting acute disseminated encephalomyelitis (ADEM), but the clinical features were atypical for demyelination. These lesions may represent a levamisole-associated vascular endotheliopathy, with a mechanism similar to posterior reversible encephalopathy syndrome. Levamisole is a no longer used chemotherapeutic agent but is a legally acquirable veterinary antihelminthic and is often used to adulterate cocaine. Given the rise in cocaine-related hospitalisations, this case raises awareness of an important ADEM mimic.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PRACTICAL NEUROLOGY","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/pn-2024-004343","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
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Abstract
A 38-year-old man developed headache, dysarthria and dysphasia after insufflation of cocaine. Brain imaging showed multiple white matter lesions, suggesting acute disseminated encephalomyelitis (ADEM), but the clinical features were atypical for demyelination. These lesions may represent a levamisole-associated vascular endotheliopathy, with a mechanism similar to posterior reversible encephalopathy syndrome. Levamisole is a no longer used chemotherapeutic agent but is a legally acquirable veterinary antihelminthic and is often used to adulterate cocaine. Given the rise in cocaine-related hospitalisations, this case raises awareness of an important ADEM mimic.
期刊介绍：
The essential point of Practical Neurology is that it is practical in the sense of being useful for everyone who sees neurological patients and who wants to keep up to date, and safe, in managing them. In other words this is a journal for jobbing neurologists - which most of us are for at least part of our time - who plough through the tension headaches and funny turns week in and week out. Primary research literature potentially relevant to routine clinical practice is far too much for any neurologist to read, let alone understand, critically appraise and assimilate. Therefore, if research is to influence clinical practice appropriately and quickly it has to be digested and provided to neurologists in an informative and convenient way.
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