Crack Cocaine Use-Related Spinal Cord Infarct.

In this study, we describe an unusual occurrence of spinal cord infarct associated with acute usage of crack cocaine. A 64-year-old male patient was brought to the hospital after being found down, displaying weakness in his lower extremities and positive for cocaine use on a urine toxicology test. The patient was administered intravenous fluids and evaluated for syncope and rhabdomyolysis. Upon initial medical assessment, the patient exhibited sensation loss up to the level of the mid-thigh, paraplegia, urinary retention, and decreased rectal sphincter tone. Neurological examination and neurological imaging were suggestive of acute spinal cord infarct.

Closed-Eye Visual Hallucinations Preceding Severe Alcohol Withdrawal.

Few existing cases of closed-eye visual hallucinations have been reported. These rare perceptual disturbances are distinct from open-eye visual hallucinations, as observed in Charles Bonnet syndrome. This case report discusses a 35-year-old male who presented with closed-eye visual hallucinations 24 hours before severe alcohol withdrawal. On initial presentation, the patient denied auditory or visual hallucinations. The day before the onset of severe alcohol withdrawal, the patient reported vivid, colorful, and lifelike visual hallucinations with his eyes closed which disappeared with eyes open. The hallucinations consisted of cartoon characters such as Daffy Duck, a lifelike blond woman with curly hair, and a tree-covered landscape. The patient endorsed awareness that the hallucinations were not real. The next day, the patient became acutely delirious with rapid onset of agitation, space-time disorientation, open-eye visual hallucinations, and emotionally disturbing illusions. The patient was promptly transferred to the intensive care unit (ICU) to manage severe alcohol withdrawal, including administration of intravenous sedation. During follow-up evaluation, the patient retained a clear memory of the closed-eye hallucinations. However, he had no recollection of the ICU course. Several etiologies were considered, including alcohol withdrawal complicated by polysubstance withdrawal and acute hepatitis, which resolved following pharmacological treatment. To the best of our knowledge, this is the first case report of its kind. Additional research is required to elucidate the etiology, mechanism, and clinical implications of closed-eye visual hallucinations.