Bilateral globus pallidus infarcts in ecstasy use.

A 41-year-old man was found unconscious at his home by a friend. He was immediately admitted to the hospital through the emergency department. At the emergency department he regained consciousness. He mentionned he had a few alcoholic beverages the night before but otherwise clinical history was negative. On physical examination swelling of the right orbital area was evident. Further clinical history and laboratory tests were unremarkable. CT scan of the brain showed the right periorbital swelling. Also noted was marked hypo density of the globus pallidus bilaterally. These areas of hypodensity showed no contrast enhancement. Next MRI of the brain was performed. On T2 weighted images symmetric hyperintensity of the globus pallidus was seen bilaterally. On diffusion weighted images strong hyperintensity was evident due to a reduction in apparent diffusion coefficient reflecting cytotoxic edema. Due to the unusual nature of these lesions further clinical history was obtained and the patient admitted to the single use of ecstasy the night before he was admitted. Follow up MRI after 3 weeks showed a decrease of signal intensity on T2 weighted images of the central area of the globi pallidi consistent with the development of liquefaction necrosis. After contrast administration there was marked enhancement of T1 weighted images likely due to passage through the bloodbrain barrier. On diffusion weighted images loss of hyperintensity was evident and an increase in apparent diffusion coefficient was seen. Further clinical evolution was unremarkable.