Introduction
cocaine is a widely used illegal drug, known for its fast ability to induce euphoria and arousal. However, cocaine exposure can contribute to several mental and physical effects. Cocaine ...induced brain damage can be divided into 3 mechanisms: direct effect leading to toxic encephalopathy, secondary to vascular damage causing vasculitis, stroke and vasospasm, and tertiary effect due to hypoxia through a cardiovascular collapse.
Objectives
Here, we report 2 young men who developed a subacute encephalopathy with different clinical and radiological presentation after a cocaine overdose
Methods
a case serie
Results
we present two men aged respectively of 28 (P1) and 42 years-old (P2). Both had a history of alcohol consumption and toxicomania (mainly cocaine) during the past year. They manifested, 2 weeks following a cocaine overdose, with gait disorder and confusion. On examination, P1 was apathic and confused. He had a subcortical frontal syndrome with gait apraxia and grasping reflex, along with a quadri-pyramidal syndrome. While patient P2 developed a cognitive decline, parkinsonism with dystonic posture of the trunk and the right limbs, and a pseudobulbar syndrome. Brain MRI was performed in both patients and showed a bilateral multifocal leukoencephalopathy (P1) and the presence of bilateral hyper T2 and FLAIR weighted images affecting basal ganglia, the mesencephalon and the periventricular cerebral white matter. Cerebrospinal fluid (CSF) analysis showed no pleocytosis and normal proteinorrachia. Electroencephalogram was also normal. Infectious differential diagnosis including Human Immunodeficiency Virus (HIV) and syphilis were excluded and metabolic screening including copper analysis, serum and CSF lactate were normal. The urine toxic screening, performed 20 days following the drug overdose, was negative. Both patients were treated with benzodiazepine and fluids without significative improvement. They were discharged with major cognitive and motor impairment.
Conclusions
cocaine toxicity is associated with high morbidity and mortality. Usually, cocaine abuse can lead to cardio-vascular, pulmonary and nervous complication. Neuropsychiatric sequelae are uncommon with less recovery potential. To date, there is no drug to prevent or cure cocaine addiction. The key is to educate the patient when he or she presents to the emergency department. Patients should be urged to seek drug counseling.
Disclosure of Interest
None Declared
Introduction
Parkinson’s disease (PD) is a chronic, neurodegenerative disorder leading to dopamine deficiency. Phenotypically, there is a wide spectrum of motor and non-motor symptoms (NMS). Among ...NMS, sexual dysfunction (SD) is one of the most disabling and crippling symptom. However, SD are usually neglected and underdiagnosed in PD patients.
Objectives
Our study aimed to estimate the effect of motor disability and the disease course on sexual dysfunction in PD patients.
Methods
This retrospective study included 42 patients (18 males and 24 females) from the department of neurology of the National Institute of Neurology Mongi Ben Hmida in Tunis, Tunisia, diagnosed with PD between 1999 and 2022. The diagnosis of PD was confirmed according to the Movement Disorder Society (MDS) diagnostic criteria of PD. The MDS Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor was used to estimate motor disability and Hoehn and Yahr (H&Y) stage was used to rate disease severity. The SD of PD patients was measured by applying the sexual items of Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction (SCOPA-AUT).
Results
SD was observed in only 11 patients (26.2%) with a sex-ratio of M/F = 1.2 and a mean age of 52 (between 40 and 72). The mean age of PD onset was 47. According to the MDS-UPDRS part III, 1 patient had a severe motor disorder (MDS-UPDRS> 59), and according to the H&Y scale, no patient had a severe stage of the disease. Nine patients had motor complications such as motor fluctuations and L-Dopa induced dyskinesia.
The SD described by our patients were: women reported Vaginal Dryness (4 patients), with difficulties reaching an orgasm (3 patients); men reported erectile dysfunction (6 patients), and difficulties in reaching an orgasm (6 patients). Among these patients, 3 were treated for SD with Tadalafil (all males).
In our study, no significant gender-related differences were found in scores related to SD in patients with PD. Neither the disease severity nor the motor disability was significantly associated to sexual disorders (respectively p=0.26 and p=0.12). Also, Motor complications induced by L-Dopa medication, assessed by the part IV of MDS-UPDRS scale, had no significant effect in the occurrence of SD in PD (p=0.78).
Conclusions
Sexual behavior has neuronal and hormonal modulation. Lack of dopamine seems to have an important role in the development of SD. However, it occurs independently of the disease severity and the motor disability. Thus, clinicians should be aware of the importance of assessing and treating such symptoms since the beginning of the disease.
Disclosure of Interest
None Declared
IntroductionVoluntary poisoning with neurotoxic products in order to achieve euphoria is common especially among young people. Neurological complications are quite likely and can be serious and ...irreversible.ObjectivesWe aim to describe the peripheral neuropathies secondary to N-Hexane intoxication in a Tunisian population.MethodsA retrospective descriptive study was carried out in our department of neurology in the NationalInstitute of Neurology of Tunis including patients diagnosed with N-Hexane neuropathy. All patientshad a history of a N-Hexane exposure. The diagnosis was confirmed after excluding other etiologiesthrough appropriate investigations. Clinical and para-clinical data as well as follow-up were assessed.ResultsWe selected 38 patients with a mean age of 22.7 years 14-36. Among them, 37 were glue-sniffer and 1 had a voluntary toxic exposure to paint. An associated cannabis consumption was found in 6 patients. All of them had a low socio-economic background and 17 were unemployed. Time to onset of neurological signs ranged from 5 months to 11 years. The clinical exam showed a quadriparesis (15,7%), a paraparesis (58%), sensory involvement (55,2%) amyotrophy (40%) and abolished tendon reflexes in lower limbs (81,5%). Swallowing disorder and optic neuritis were found in one case. The electroneuromyogram revealed an axono-demyelinating sensory-motor polyneuropathy (PN) in 16 cases and a demyelinating motor PN in 9 cases. Vitamin therapy, motor rehabilitation and psychotherapy sessions have been indicated. Only 6 patients showed slight clinical improvement after withdrawal. The rest of our patients did not quit; 84% of them became bedridden.ConclusionsGlue-sniffer related neuropathy is very common in our country especially in adolescents and young adults with low socio-economic background. The neurological outcome is serious and usually irreversible if exposure is persistent.Disclosure of InterestNone Declared
