Cocaine abuse is a well known cause of cerebrovascular complications. An inflammatory vasculopathy hypothesis has been proposed, but the medical literature has only reported a few pathological confirmations. We report a case with a biopsy demonstrating cerebral inflammatory vascular changes that are associated with
cocaine abuse. A 21-year-old male, a twice weekly
cocaine abuser, developed
encephalopathy,
apraxia and left
hemiparesis with hemisensory loss during the first week after his last
cocaine intake; postural
tremor and
dystonia appeared later. Laboratory data were unrevealing. Cerebral angiography showed a lack of vascularization in the left precentral and central arterial groups. A corticomeningeal cerebral biopsy demonstrated perivascular cell collection and transmural lymphomonocytic infiltration of the small cortical vessels. All symptoms improved with
corticosteroid treatment, but 4 years later, the patient returned with a worsening of his
encephalopathy and a severe memory impairment, emotional lability and
apraxia. A cerebral magnetic resonance image (MRI) showed subcortical and periventricular lesions suggesting ischemic damage in small-size vessel areas as well as cortical
atrophy. This new case supports the existence of an
encephalopathy associated with vascular inflammatory changes in a
cocaine abuser, although more clinical and experimental data are necessary to define its physiopathology.