PMC6696843_01
Inpatient brain MRI during the acute stage of cocaine-induced toxic leukoencephalopathy (hospital day 3; 8 days after onset of symptoms) showed widespread and symmetric T2-FLAIR and DWI hyperintensities in the subcortical white matter with low ADC in some areas (restricted diffusion) and high ADC in other areas (T2 shine-through effect). The cerebral cortex was spared and the cerebellum, basal ganglia, thalamus, and brainstem were all normal (the latter structures are not shown).
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T2-FLAIR and diffusion-weighted imaging (DWI) with low-apparent diffusion coefficient (ADC) in some areas (restricted diffusion) and high ADC in other areas (T2 shine-through effect). The cerebral cortex, cerebellum, basal ganglia, thalamus, and brainstem were all normal (Figure1).
EEG showed mild diffuse slowing with inordinate amounts of arrhythmic asynchronous theta waves mixed with low-voltage beta and alpha activity. This finding is a good match with the mild neuropsychiatric manifestations and preservation of consciousness but not with the widespread white matter abnormality on MRI. The latter if caused by widespread demyelination or axonal injury would result in more prominent slow wave activity. Display parameters: longitudinal bipolar montage (from top to bottom: LT-LP-RP-RT-ECG), digital filter bandpass of 1 to 70 Hz, and 60-Hz notch filter turned on; voltage-time scale is superimposed on the tracing.
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EEG showed mild diffuse slowing with inordinate amounts of theta waves intermixed with low-voltage beta and alpha activity (Figure 2).
Outpatient brain MRI performed 5 months after the initial inpatient MRI (compare with Figure 1) showed near-100% resolution of subcortical white matter hyperintensity on T2-FLAIR. Diffusion-weighted imaging showed complete resolution of restricted diffusion (normal DWI and ADC).
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Follow-up brain MRI showed complete absence of diffusion restriction and near-100% resolution of white matter hyperintensity (Figure 3).
Outpatient EEG recorded 5 months after recording the initial inpatient EEG (compare with Figure 2) showed normal alpha rhythm posteriorly and normal beta activity anteriorly during wakefulness. Display parameters: longitudinal bipolar montage (from top to bottom: LT-LP-RP-RT-ECG), digital filter bandpass of 1 to 70 Hz, and 60-Hz notch filter turned on; voltage-time scale is superimposed over the tracing.
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Follow-up EEG showed normal alpha rhythm posteriorly and normal beta activity anteriorly during wakefulness (Figure 4).