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Moyamoya tipping point: fatal bilateral MCA territory infarction following cocaine abuse
  1. Mark Daniel Unger1,
  2. Joseph Georges2,
  3. Hamza A Shaikh2,
  4. Tapan Kavi3
  1. 1Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
  2. 2Neurosurgery, Cooper University hospital, Camden, NJ
  3. 3Department of Neurology and Neurosurgery, Cooper University Hospital, Camden, NJ, USA
  1. Correspondence to Dr Tapan Kavi, Kavi-Tapan{at}

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An adult Caucasian man with a history of polysubstance abuse was found unresponsive by the nursing staff at his rehabilitation centre and intubated by emergency medical services. On examination, he was stuporous, his eyes did not open to stimulation, his pupils were reactive, localised to pain with bilateral upper extremities and demonstrated triple flexion to noxious stimuli in the bilateral lower extremities. Urine toxicology was positive for cocaine metabolites. A CT scan of the head was performed, which showed possible hypodensities in the bilateral temporal lobes. MRI of the brain was performed to further characterise these hypodensities, and it revealed bilateral middle cerebral artery (MCA) infarction and generalised cerebral …

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