A 31-year-old woman who used cocaine base paste.
Emergency consultation after three days of persistent headache, dysarthria, difficulty swallowing and decreased strength of the right hemibody.
Right hemiparesis and hypodense biparesis images in computerized axial tomography (CAT) were found.
The patient refused hospitalization.
Two weeks later, the patient was brought by relatives suffering from symptoms, visual disturbance and impaired consciousness.
She was admitted with disorientation, dysarthria, right hemiparesis, normal eye fundus.
Cerebrospinal fluid, blood count, creatinine, blood glucose, urea nitrogen and normal plasma electrolytes.
Serology for herpes virus 1, 2 and 6, human immunodeficiency virus (HIV) and cytomegalovirus were negative, as well as for toxoplasma and Mycoplasma.
Two days after fever 39°C, desaturating 77%, aspiration pneumonia was identified.
Magnetic resonance imaging (MRI) of the brain showed multiple hyperintense lesions on T2-weighted sequences and FLAIR sequences that partially captured contrast.
Retrieved from pneumonia, he acquired spontaneous surveillance, gaze directed and obeyed simple commands, however, motor impairment in the right limbs was increased bilateral Baflexia of the left extremity.
Electroencephalogram showed diffuse delta slowness, with no reactivity to photostimulation.
The sound was preserved and the paresis progressed to plejias one week later.
It was decided to treat as ADEM, boluses of 1 g of methylprednisolone were initiated.
It appears intermittent trismus, keeps eyes open with feverish response to threat, without establishing contact.
Two days later, a second bolus of methylprednisolone was administered, the fever reappeared and the patient died.
