Bilateral hippocampal stroke secondary to acute cocaine intoxication

Abstract

Hippocampal infarction is a rare complication of cocaine use, with only two cases previously reporting this association. We present a 44-year-old male who developed a persistent amnesic syndrome following cocaine intoxication. Examination identified no other neurological deficits. Subsequent MRI brain revealed high FLAIR signals and diffusion restriction in the hippocampus and centrum semiovale bilaterally, consistent with infarction. These findings were in keeping with the results of formal neuropsychological testing where deficits in both verbal and visual episodic memory and learning capacity were identified, consistent with hippocampal dysfunction. In contrast to previous reports, this presentation occurred in the absence of other vascular risk factors or hypoxic insults.

Figure 1:

MRI brain—bilateral hippocampal infarcts. MRI brain (axial view) revealed high FlAIR signal changes in bilateral hippocampi and the right uncus (left image) with diffusion restriction–high signal on DWI (middle image) and low signal on ADC (right image).

Figure 2:

MRI brain—bilateral centrum semiovale infarcts. Corresponding abnormalities in the centrum semiovale bilaterally consistent with acute infarction.