Abstract

Introduction:Toxic encephalopathy is damage to the brain after toxin exposure with different toxins damaging different areas of the brain. Toxins can be occupational or illicit drugs. This case report illustrates the importance of meta-analysis for the evolving care of patients who use multiple illicit drugs. We explore the pathophysiology and address changes in imaging to the brain with MDMA and marijuana use. Discordant physical exam and imaging results are discussed. This case is unique with patient presentation, combination illicit drug use, and imaging findings.
Case Description: We present a case where chronic use of MDMA and marijuana present symptoms of encephalopathy, but do not match with imaging, symptom, and testing for single methamphetamine use.
Conclusion: Additional testing and research is needed to determine the effects of combination illicit drug use, specifically marijuana and MDMA to appropriately map areas of damage in the brain. In a patient presenting with symptoms of encephalopathy, with chronic use of both MDMA and marijuana, confounding results are found on symptom review, physical exam, and imaging studies. Further study is warranted to determine the combined effects of illicit drugs on damage to the brain.

Keywords:Case report; Toxic encephalopathy; Marijuana; MDMA; Ataxia

Abbreviations:ADTE=Acute Diffuse Toxic Encephalopathy; CTE=Chronic Toxic Encephalopathy; MDMA=3,4-Methylenedioxymethamphetamine; EEG=Electroencephalography; CT=Computed Tomography; MRI=Magnetic Resonance Imaging; PET=Positron Emission Tomography; MRS=Magnetic Resonance Spectroscopy; fMRI=Functional Magnetic Resonance Imaging; SPECT=Single-Photon Emission Computed Tomography; HIV=Human Immunodeficiency Virus; SARS Cov-2 NAA=Severe Acute Respiratory Syndrome Coronavirus 2 Nucleic Acid Amplification; MDA=Methylenedioxyamphetamine; THC=Tetrahydrocannabinol; DNA=Deoxyribonucleic Acid