Malta doctors treat rare cocaine disorder that can ‘eat away’ at brain

A rare case of induced toxicity in the brain of a cocaine user has exposed the frightening reality of taking too much cocaine.

The images of the brain scans from Mater Dei Hospital were obtained from Maltese doctors who treated a 45-year-old Briton.

The scans reveal how cocaine can ‘eat away’ at the brain, leaving victims disabled, or even dead.

The rare but severe side-effect of taking cocaine was determined after the 45-year-old patient was admitted to Mater Dei Hospital, acting confused and behaving bizarrely. Dr Ylenia Abdilla, who treated the unnamed man, wrote in the BMJ Case Reports that medics had realised he was suffering cocaine-induced toxic leukoencephalopathy.

“It’s a rare disorder which can cause significant disability,” she said. “This case study is intended to increase awareness of this condition. The prognosis is generally poor and can be rapidly fatal, however some rare cases recover fully, as is seen in this case report.”

“It’s a rare disorder which can cause significant disability,” Ylenia Abdilla said. “This case study is intended to increase awareness of this condition. The prognosis is generally poor and can be rapidly fatal”

Abdilla and colleagues at the Mater Dei Hospital in Malta, treated the man two to three days after he had last taken cocaine. The 45-year-old regular user was rushed into A&E by his parents after two days of being confused.

Doctors noted his pupils were dilated and “briskly reactive to light”, and that the patient was “not cooperative, unable to perform simple tasks and was not following commands”.

Abdilla’s team sent their patient for MRI scans on his brain. They revealed damage to the white matter in the brain, and doctors diagnosed him with the rare condition cocaine-induced toxic leukoencephalopathy.

“It may present itself in several different ways. These include an altered level of consciousness, confusion, impaired language, altered vision, fever or spasticity,” Abdilla said.

“Prognosis is poor – the condition progresses rapidly and often leads to death. Rarely it has been reported to result in complete recovery, as in our case.”

Scans revealed he had suffered permanent changes to the white matter in his brain, which is made up of nerves that control learning.

Images from MRIs done regularly during his recovery show parts of the brain glowing bright white, indicating that nerve cells in the white matter have died. 

And tests performed when the man came round from his coma showed he had a level of brain damage consistent with a condition closely linked to dementia.

Toxic leukoencephalopathy is a condition in which there is injury to the white matter in the brain which gets progressively worse – it is often fatal.

White matter is made of nerve cells deep inside the brain, surrounded by an outer layer of grey matter. It plays a role in controlling learning, problem-solving, walking and balancing, and someone’s mood.

Concerned that the man may have an infection in his brain, doctors gave him antibiotics and antiviral drugs but he continued to get more unwell. He could remember hitting his head twice within the past two weeks and his parents said it had only been two days since he last took cocaine.

Doctors found he had a bacterial infection in a cut above his eye and put him into intensive care where MRI scans revealed his brain damage was getting worse.

Eventually the man was transferred to a rehab facility, where he showed signs of improving. After four months, he was walking independently, and coping with most aspects of daily life.

The patient was treated for anxiety and managed to stay off drugs – meaning he was allowed home a month later.

One year after he was admitted to hospital, the man returned for a follow up. He had not used drugs for a year, and while his brain scan still showed “persistent white matter changes”, neurological tests were normal. “Apart from some complaints of low mood, he was fully independent and had returned to his previous functional status,” Abdilla’s team noted.

Brain damage

Cocaine has been found to have a number of physical effects on the body which can cause temporary or permanent brain damage.

When the drug gets into the blood vessels it causes blood pressure to rise, heart rate to increase and is toxic to the cells in the linings of the veins and arteries.

This damage to the vessels which carry oxygen has knock-on effects on the brain because its vital blood supply can be reduced by the damage, essentially starving it of nutrients.

Regular cocaine users have also been found to have fewer sugars being used in their brain, suggesting that cells in the organ are not using as much energy because of weakness or have died completely.

Another study found cocaine increases the rate at which a person’s brain ages. Scientists at the University of Cambridge found that while average people naturally lose 1.69ml of grey matter each year as they age, past or present cocaine users lose almost double this amount – 3.08ml per year.

Source: American Addiction Centers