Cerebellar talcosis following posterior reversible encephalopathy syndrome in an intravenous methamphetamine abuser

Nidal Bassam Omar; Gustavo Chagoya; Galal A Elsayed; Silvio H Litovsky; James R Hackney; Winfield S Fisher

doi:10.25259/SNI_616_2020

Cerebellar talcosis following posterior reversible encephalopathy syndrome in an intravenous methamphetamine abuser

Surg Neurol Int. 2021 Jan 5:12:2. doi: 10.25259/SNI_616_2020. eCollection 2021.

Authors

Nidal Bassam Omar¹, Gustavo Chagoya¹, Galal A Elsayed¹, Silvio H Litovsky², James R Hackney², Winfield S Fisher¹

Affiliations

¹ Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, United States.
² Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States.

Abstract

Background: Intravenous (IV) methamphetamine abuse is associated with a variety of short- and long-term effects on the nervous system, some of which have yet to be fully elucidated. One known systemic complication that has not been described in nervous system tissues is the deposition of substrate crystals contained in injectable drugs.

Case description: An unusual case is presented of a 35-year-old active IV methamphetamine abuser with posterior reversible encephalopathy syndrome (PRES) who subsequently developed multifocal bilateral cerebellar enhancing lesions and leptomeningeal enhancement due to biopsy-proven crystalline deposits.

Conclusion: Although large crystalline substances will not normally penetrate the blood-brain barrier (BBB), during a state of BBB compromise such as with PRES, talc deposition may occur in the central nervous system.

Keywords: Intravenous drug abuse; Methamphetamine; Positively birefringent crystals; Posterior reversible encephalopathy syndrome; Talc; Talcosis.

Publication types

Case Reports