title: Cocaine-induced encephalocele: case report and literature review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA. lanrsg@optonline.net
authors.forename: Ladislau
authors.initials: L
authors.lastname: Albert
authors.forename: Joseph A
authors.initials: JA
authors.lastname: DeMattia
mesh_terms: D003042:Cocaine / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications*; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects; D004677:Encephalocele / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine