Basal ganglia ischemia by aspirated heroin and cocaine intoxication

Abstract

Cocaine is one of the most widely abused drugs all over the world which is associated with the occurrence of ischemic events and bleeding in the central nervous system and cardiovascular system. This is because of various factors including: vasospasm, cerebral vasculitis, increased platelet aggregation, cardioembolism and hypertensive emergencies associated with impaired cerebral autoregulation. We describe a case of a patient who is admitted with acute intoxication due to cocaine and heroin aspiration. Presenting with acute myocardial infarction (AMI) with ST segment elevation in V1, V2 and V3, increased troponin, hypomagnesemia, hyperkalemia, hypocalcemia, mixed acidosis, aspiration pneumonia, depression of consciousness with shallow breathing, cyanosis and withdrawal syndrome which was treated with haloperidol at intensive care unit. Then, the patient presents with extrapyramidalism suggesting the appearance of an adverse event with this treatment. For this reason, haloperidol was suspended and biperidene and bromocriptine were started without total remission of symptoms. Finally, basal ganglia ischemia was evidenced by magnetic resonance imaging. The aim of this report is to describe the clinical manifestations associated with the atypical consumption of these two psychoactive substances that were consumed by this patient as well as a therapeutic approach to the triggered disease.