{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:19:36Z","timestamp":1793146776806,"version":"4.5.0"},"reference-count":8,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2024,11,5]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>A 38-year-old man developed headache, dysarthria and dysphasia after insufflation of cocaine. Brain imaging showed multiple white matter lesions, suggesting acute disseminated encephalomyelitis (ADEM), but the clinical features were atypical for demyelination. These lesions may represent a levamisole-associated vascular endotheliopathy, with a mechanism similar to posterior reversible encephalopathy syndrome. Levamisole is a no longer used chemotherapeutic agent but is a legally acquirable veterinary antihelminthic and is often used to adulterate cocaine. Given the rise in cocaine-related hospitalisations, this case raises awareness of an important ADEM mimic.<\/jats:p>","DOI":"10.1136\/pn-2024-004343","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T13:20:35Z","timestamp":1733318435000},"page":"373-376","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Sniffed levamisole-adulterated cocaine mimicking acute demyelinating encephalomyelitis"],"prefix":"10.1136","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-7836","authenticated-orcid":false,"given":"Joshua","family":"Yap","sequence":"first","affiliation":[{"name":"Neurology, Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia"},{"name":"Neurology, Gold Coast University Hospital, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Ward","sequence":"additional","affiliation":[{"name":"Neurology, Gold Coast University Hospital, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Broadley","sequence":"additional","affiliation":[{"name":"Neurology, Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"2025090409282110000_25.4.373.1","doi-asserted-by":"crossref","first-page":"E281","DOI":"10.1503\/jpn.200057","article-title":"Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions","volume":"46","author":"Conrad","year":"2021","journal-title":"J Psychiatry Neurosci"},{"key":"2025090409282110000_25.4.373.2","article-title":"Trends of Cocaine Use and Manifestations in Hospitalized Patients: A Cross-Sectional Study","volume":"14","author":"Gangu","year":"2022","journal-title":"Cureus"},{"key":"2025090409282110000_25.4.373.3","first-page":"536","article-title":"The cocaine cutting agent levamisole is frequently detected in cocaine users","volume":"50","author":"Pope","year":"2018","journal-title":"Pathol (Phila)"},{"key":"2025090409282110000_25.4.373.4","doi-asserted-by":"crossref","DOI":"10.1177\/2050313X20940532","article-title":"Bal\u00f2\u2019s concentric sclerosis in a case of cocaine-levamisole abuse","volume":"8","author":"Grasso","year":"2020","journal-title":"SAGE Open Med Case Rep"},{"key":"2025090409282110000_25.4.373.5","doi-asserted-by":"crossref","unstructured":"Deracinois B , Lenfant A-M , Dehouck M-P , et al . Tissue non-specific alkaline phosphatase (TNAP) in vessels of the brain. In: Fonta C , N\u00e9gyessy L , eds. Neuronal Tissue-Nonspecific Alkaline Phosphatase (TNAP). Dordrecht: Springer Netherlands, 2015: 125\u201351.","DOI":"10.1007\/978-94-017-7197-9_7"},{"key":"2025090409282110000_25.4.373.6","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1989.00520450059019"},{"key":"2025090409282110000_25.4.373.7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17756\/jnen.2018-032","article-title":"Acute Cocaine Exposure and Cerebrovascular Diseases: A Retrospective Clinical Study and Literature Review","volume":"04","author":"Si","year":"2018","journal-title":"J Neurol Exp Neurosci"},{"key":"2025090409282110000_25.4.373.8","doi-asserted-by":"crossref","first-page":"104418","DOI":"10.1016\/j.msard.2022.104418","article-title":"Levamisole-associated multifocal inflammatory encephalopathy: clinical and MRI characteristics, and diagnostic algorithm","volume":"69","author":"Fominykh","year":"2023","journal-title":"Mult Scler Relat Disord"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2024-004343","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T16:28:27Z","timestamp":1757003307000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2024-004343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,4]]},"references-count":8,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,7,14]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/pn-2024-004343"],"URL":"https:\/\/doi.org\/10.1136\/pn-2024-004343","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,4]]}}}