Disclosures: Michael D. Harbus, DO: Nothing to disclose

Case Description: The patient is a 27-year-old male with no past medical history who presented to the emergency room after ingesting an unknown drug while at an electrical dance music festival. Upon arrival, the patient was unresponsive, tachycardic, hypotensive, and febrile to 108.0 degrees Fahrenheit. His urine toxicology was positive for amphetamines and cannabinoids. His CT on admission showed infarcts of the bilateral cerebellar hemispheres. His labs were significant for the following values: troponin of 9.92, CPK of greater than 33000, ALT of 5119 and AST of 4353. After stabilization on the neurosurgical and medicine floors, the patient was transferred to the inpatient rehabilitation unit. Upon initial assessment, the patient demonstrated poor arousal, hypophonia, dysmetria, and frequent episodes of dizziness and vomiting.

Setting: Acute Inpatient Rehabilitation Unit

Patient: 27-year-old male presenting after a drug overdose.

Assessment/Results: The patient was started on amantadine, which improved his wakefulness and facilitated his participation in therapy. For his episodic vomiting and dizziness, meclizine was initiated prior to his scheduled therapy, leading to drastic symptomatic improvement. As the patient’s cerebellar symptoms subsided and his arousal improved, his diet was advanced from chopped to regular, his vocal volume improved, and he progressed from ambulating 50 feet with moderate assistance to ambulating 150 feet with distant supervision.

Discussion: Central nervous system infarctions have been reported following cocaine overdoses and there has been a reported case of bilateral cerebellar edema following ketamine use. However, to our knowledge, this is the first case of bilateral cerebellar infarction in the setting of an amphetamine overdose.

Conclusion: This case shows that severe hyperthermia, end-organ damage, and cerebellar brain injury can occur in the setting of amphetamine overdose. It also shows that symptom-focused medical management and an intensive therapy program are both essential in optimizing a patient’s functional status.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-cerebellar-infarction-following-an-amphetamine-overdose-a-rare-case-of-dizziness-dysphagia-and-dysphonia/