TY - JOUR T1 - Moyamoya tipping point: fatal bilateral MCA territory infarction following cocaine abuse JF - BMJ Case Reports DO - 10.1136/bcr-2017-222883 VL - 2018 SP - bcr-2017-222883 AU - Mark Daniel Unger AU - Joseph Georges AU - Hamza A Shaikh AU - Tapan Kavi Y1 - 2018/01/18 UR - http://casereports.bmj.com/content/2018/bcr-2017-222883.abstract N2 - 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 … ER -