{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:15Z","timestamp":1794324255811,"version":"4.9.0"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p>With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or \u201csnorting.\u201d Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. Occasionally, cocaine-induced lesions cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate and can mimic other diseases such as tumors, infections, and immunological diseases. In the literature currently available, involvement of the craniovertebral junction in the cocaine-induced midline destructive lesions (CIMDLs) has never been reported.<\/jats:p>\n                  <jats:p>The present case concerns a 44-year-old man who presented with long-standing symptoms including nasal obstruction, epistaxis, dysphagia, nasal reflux, and severe neck pain. A diagnosis of CIMDL was made in light of the patient\u2019s history and the findings on physical and endoscopic examinations, imaging studies, and laboratory testing. Involvement of the craniovertebral junction in the destructive process was evident. For neurosurgical treatment, the authors considered the high grade of atlantoaxial instability, the poorly understood cocaine-induced lesions of the spine and their potential evolution overtime, as well as cocaine abusers\u2019 poor compliance. The patient underwent posterior craniovertebral fixation. Understanding, classifying, and treating cocaine-induced lesions involving the craniovertebral junction are a challenge.<\/jats:p>","DOI":"10.3171\/2014.11.spine1471","type":"journal-article","created":{"date-parts":[[2015,5,8]],"date-time":"2015-05-08T10:01:00Z","timestamp":1431079260000},"page":"159-165","source":"Crossref","is-referenced-by-count":10,"title":["Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report"],"prefix":"10.3171","volume":"23","author":[{"given":"Carlo","family":"Brembilla","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Andrea","family":"Lanterna","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Risso","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Bombana","sequence":"additional","affiliation":[{"name":"Infectious Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gritti","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Trezzi","sequence":"additional","affiliation":[{"name":"Pathology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bonaldi","sequence":"additional","affiliation":[{"name":"Neuroradiology, Pope John XXIII Hospital, Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Biroli","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine1471","series-title":"Acad Emerg Med","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1111\/j.1553-2712.2001.tb01132.x","article-title":"Reliability of the visual analog scale for measurement of acute pain","volume":"8","author":"Bijur","year":"2001"},{"key":"b2-spine1471","series-title":"Acta Otorhinolaryngol Ital","first-page":"247","article-title":"Psychological aspects and treatment of patients with nasal septal perforation due to cocaine inhalation","volume":"28","author":"Businco","year":"2008"},{"key":"b3-spine1471","series-title":"Acta Otorrinolaringol Esp","first-page":"414","article-title":"Centrofacial necrosis secondary to cocaine use","volume":"50","author":"Caravaca","year":"1999"},{"key":"b4-spine1471","series-title":"Int J Oral Maxillofac Surg","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.ijom.2007.03.015","article-title":"Cocaine-related syndrome and palatal reconstruction: report of a series of cases","volume":"36","author":"Di Cosola","year":"2007"},{"key":"b5-spine1471","series-title":"Flash Eurobarometer 233: Young people and drugs among 15\u201324 year-olds. 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