Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA.
Neurosurgery. 2011 Jan;68(1):E263-6. doi: 10.1227/NEU.0b013e3181fead2e.
The abuse of cocaine can lead to significant destruction of midline craniofacial structures. This process occurs secondary to myriad mechanisms, including ischemic necrosis, irritation by chemical adulterants, and direct trauma during its administration. Coupled with a prolonged chronic infection of intranasal and anterior skull base regions, an encephalocele can be formed. We report a case of an encephalocele secondary to cocaine use and its associated complications.
A 56-year-old man presented with altered mental status and cerebritis secondary to the presence of an intranasal encephalocele. On computed tomography, extensive destruction of the anterior cranial fossa was observed. The patient had a 30-year history of intranasal cocaine abuse, and his urine tested positive for the presence of cocaine on admission. The patient was treated with intravenous antibiotics and underwent a repair of his cranial defect and resection of the encephalocele. The patient made a good recovery after treatment.
Alternative causes of an encephalocele, including trauma, surgery, and congenital malformation, were ruled out in this patient. Histopathological analysis of the necrotic tissue and the absence of renal or pulmonary disease also indicated that the patient did not suffer from Wegener granulomatosis, a known cause of spontaneous intranasal lesions. To the best of our knowledge, this is the first report of an encephalocele likely induced solely by cocaine abuse.
可卡因滥用可导致中线颅面结构严重破坏。这一过程发生的原因众多，包括缺血性坏死、化学杂质刺激以及给药时的直接创伤。此外，鼻内和颅前底区域的慢性感染也会导致脑膨出。我们报告一例可卡因使用引起的脑膨出及其相关并发症。
一名 56 岁男性因鼻内脑膨出引起的精神状态改变和脑炎症就诊。计算机断层扫描显示前颅窝广泛破坏。患者有 30 年的鼻内可卡因滥用史，入院时尿液可卡因检测呈阳性。患者接受了静脉抗生素治疗，并进行了颅骨缺损修复和脑膨出切除术。经治疗后，患者恢复良好。
该患者已排除其他原因引起的脑膨出，包括创伤、手术和先天畸形。坏死组织的组织病理学分析以及无肾或肺疾病也表明患者未患有韦格纳肉芽肿，这是一种已知的引起自发性鼻内病变的原因。据我们所知，这是首例可能仅由可卡因滥用引起的脑膨出报告。
