{
  "abstract": "No guidelines exist regarding the management of cocaine-induced toxic leukoencephalopathy, with variable reports as to the effect of steroid treatment on outcome. We describe the case of a 51-year-old gentleman who presented to the emergency department obtunded following a suspected overdose. Urine toxicology was positive for cocaine. He was admitted to intensive care for a period of multi-organ support, and following stepdown to a medical ward was found to have perseveration of speech and dysphasia. Addenbrooke’s Cognitive Examination (ACE)-R revealed significant cognitive impairment, with an initial score of 25/98. Neurological examination was otherwise normal. A diagnosis of cocaine-induced toxic leukoencephalopathy was made based on suggestive magnetic resonance brain imaging (MRI) changes, with symmetrical, abnormal high T2-weighted signal, and mild diffusion restriction throughout the cerebral white matter. Treatment with high-dose prednisolone was initiated at 60mg once daily, with a planned dose reduction of 10mg every five days. Improvement was noted on serial MRI and cognitive assessment, with near complete recovery achieved following a period of neurorehabilitation, and a score of 89/100 on ACE-III at the end of treatment. This case, in combination with some of the pre-existing literature, may prompt consideration of corticosteroids in patients with a similar presentationa.hamilton-shield@nhs.net",
  "authors": [
    {
      "affiliations": [
        "Hammersmith Hospital, Du Cane Road, London"
      ],
      "name": "Naeem Sidra"
    },
    {
      "affiliations": [
        "Hammersmith Hospital, Du Cane Road, London"
      ],
      "name": "Hamilton-Shield Antonia"
    },
    {
      "affiliations": [
        "Hammersmith Hospital, Du Cane Road, London"
      ],
      "name": "Tan Elizabeth"
    },
    {
      "affiliations": [
        "National Hospital for Neurology and Neurosurgery, Queen’s Square, London"
      ],
      "name": "Vonberg Frederick"
    },
    {
      "affiliations": [
        "Hammersmith Hospital, Du Cane Road, London"
      ],
      "name": "Dixon Luke"
    },
    {
      "affiliations": [
        "Hammersmith Hospital, Du Cane Road, London"
      ],
      "name": "Dani Melanie"
    }
  ],
  "title": "226 Cocaine and confusion: a case of toxic leukoencephalopathy",
  "uid": "71fcd409-a87c-5f2a-a560-70e630b87930"
}