Acute toxic reversible amnesia
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Acute toxic reversible amnesia M. A. Ruiz Yanzi1 · L. Alessandro1 Received: 23 July 2019 / Accepted: 5 November 2019 © Belgian Neurological Society 2019
Keywords Amnesia · Cognitive neurology · Toxic · Cocaine · Neuroimages · Hippocampus A 34-year-old man with a history of type I diabetes with deficient glycemic controls is brought to the emergency room for sudden anterograde amnesia. He was last seen asymptomatic by a family member 12 h before consultation, after having consumed marijuana and cocaine. On examination, the patient had a Montreal Cognitive Assessment (MoCA) score of 24/30 (− 5 memory, − 1 orientation), without impaired consciousness, neck rigidity or neurological signs, and clinical examination was normal (temperature 36.1 °C, blood pressure 125/78 mmHg). The patient and his family denied fever, chills, myalgias, respiratory symptoms, headache, behavioural manifestations and seizures during the last week. Toxicological screening tests revealed positive results for cocaine and marijuana in urine. Brain MRI showed bilateral cortical hippocampal diffusion restriction with hyperintensity in T2/FLAIR weighted sequences, without abnormal contrast-enhancement or other brain lesions (Fig. 1a, b). Intracranial angiography showed no signs of vasoconstriction. Glycemic control (120 mg/dl) and further laboratory tests (white blood cell count, ESR, CRP, haemoglobin, renal function, CPK, carboxyhemoglobin) were normal. Cerebrospinal fluid (CSF) revealed no alterations: WBC 2/mm3, glucose 104 mg/dl, protein 33.88 mg/dl, lactic acid 1.7 mmol/l. CSF culture and CSF HSV I, HSV II, HHV6, VZV, CMV, EBV, mycoplasma and enterovirus PCR were negative. EEG, EKG, and echocardiogram, were normal. Without immunosuppressants, antibiotics or any specific treatment, the patient progressively recovered from his memory impairment. A month later, the patient had a MoCA score of 30/30 and had not been consuming cocaine * M. A. Ruiz Yanzi [email protected] 1
Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
or marijuana. Brain MRI exhibited almost complete resolution of the injury to the hippocampus without volume loss (Fig. 1c, d) and without vasoconstriction. It was concluded that the patient could have suffered from toxic amnesia due to cocaine and marijuana use. Acute onset amnestic syndromes related to toxicological exposure, with this type of characteristic imaging in MRI, have been rarely described in literature [1]. This disorder has been linked mainly to the consumption of psychoactive drugs, specially opioids, cocaine and marijuana. It is believed to be due to a hypoxic lesion secondary mainly to vasospasm in cortical microvasculature or secondary to systemic complications causing decreased brain perfusion in the susceptible cortical hippocampal region [2]. Most patients present with anterograde amnesia. Deficits in orientation, disjunctive alterations and variable degrees of sensory deterioration are other common symptoms. In brain MRI, ischemi
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