CEREBRAL-ISCHEMIA CAUSED BY DESIGNER DRUGS IN A YOUNG MAN

History and clinical findings: A 29-year-old man reported two episodes , 3 months apart, of dysarthria, each lasting for several hours. It wa s associated with hypaesthesia over the cheeks. Neurological examinati on several hours later was unremarkable. On direct questioning the pat ient reported that he had been taking marihuana and cocaine immediatel y before each episode. There was also a history of regular abuse of va rious drugs over several years by this socially well integrated young man. Investigations: Cranial computed tomography, cranial magnetic res onance imaging and cerebral scintigraphy indicated multiple cortical a nd subcortical ischaemic lesions of different sizes and ages. EGG, lon g-term ECG monitoring, transoesophageal echocardiography and upper abd ominal sonography were normal. Cerebrospinal fluid revealed a slightly abnormal blood-brain barrier (5.3 g/l protein, albumin ratio of 7.3). Autoantibody titres and coagulation and serological tests for neurotr opic bacteria and viruses were normal. Urinary drug screening was posi tive for cannabinoids. Diagnosis, treatment and course: We assume that the patient had transitory cocaine-induced ischaemic attacks (TIA) an d clinically silent cerebrovascular accidents (CVA). He was discharged without specific treatment after being informed of the severe neurolo gical sequelae of his drug abuse. Conclusions: The rising abuse of >>d esigner drugs<< is of increasing diagnostic significance in TIA-like s ymptoms and CVAs in young adults, which may be of haemorrhagic or isch aemic aetiology. Thromboembolic, vasospastic or vasculitic factors pla y a pathogenetic role. Early performance of appropriate blood and urin e tests is of great diagnostic importance.