Cocaine and pupillary-sparing oculomotor nerve paresis

Abstract

Cocaine use has been associated with a variety of neurologic disturbances, including ischemic and hemorrhagic cerebral infarcts, subarachnoid hemorrhage, psychosis, coma, syncope, seizures, myoclonus, dystonic reactions, vertigo, headache, and paresthesias.1-4 We report on a patient who developed a pupillary-sparing oculomotor cranial nerve III (CNIII) paresis after the use of crack cocaine. Case report. A 29-year-old African-American man presented with a 2-week history of right ptosis, double vision, and headache. The patient admitted to the occasional use of cocaine. On the evening before the onset of symptoms, he inhaled cocaine by dusting the drug onto a cigarette that he then smoked. He awakened the next morning with a throbbing right retro-orbital headache, drooping of the right eyelid, and predominantly side-by-side double vision. From the time of onset to initial evaluation 2 weeks later, he had persistent right-sided ptosis, intermittent right frontal/retro-orbital throbbing headache, and double vision. He smoked cocaine once after the onset of his symptoms …