Transient Neurogenic Bowel Dysfunction in a Case of Cocaine-Induced Spinal Cord Infarction

Abstract

A 23-year-old male presented to the hospital with altered mental status (AMS) and hypoglycemia requiring admission to the ICU. He had improvement in AMS after administration of dextrose 50% and naloxone and endorsed the use of alcohol, cocaine, and marijuana that morning. It was confirmed with a positive urine toxicology screen for cocaine and tetrahydrocannabinol (THC). During this hospital admission, his physical examination was notable for paraplegia with no motor abilities from the T6 dermatome and below. Sensation was intact throughout all dermatomes but he was found to have urinary retention. Workup included an abnormal MRI showing T2 signal spanning from T2-T8, raising a high suspicion of a probable acute ischemic spinal cord infarction. Several hours after admission, the patient began to exhibit the first signs of abnormal bowel function and experienced one episode of hematemesis, prolonging his ICU stay.

Keywords: cocaine; constipation; neurogenic bowel dysfunction; spinal cord infarction; upper gastrointestinal bleeding.

Figure 1. MRI of thoracic spine shows abnormal T2 signaling spanning from T2-T8, highly suspicious for an acute spinal cord infarction (focal cord swelling and "pencil-like" hyperintensities on T2-weighted images).

Figure 2. MRI of thoracic spine shows abnormal T2 signaling at the level of T3.