Traumatic cerebral haemorrhagic contusion associated with cocaine-induced ANCA- associated vasculitis

<h3></h3> ANCA-associated vasculitis is a rare yet recognised side-effect of cocaine use. It is attributed to the levamisole component, added to potentiate the stimulatory effects and increase dealer profit. We present a case of cerebral haemorrhagic contusion, presumed traumatic, following collapse and generalised seizure, which led to the diagnosis of cocaine-induced ANCA-associated vasculitis. A 25-year-old woman developed a severe headache and had a seizure after consuming 5g of cocaine and vodka. Neurological examination was normal. An initial CT head demonstrated hypodensity within the left temporal lobe, along with a small intraparenchymal haemorrhage and subdural hematoma. MRA excluded reversible cerebral vasoconstriction syndrome, while MRV excluded cerebral venous sinus thrombosis. MRI head showed a poorly enhancing focus within the left inferior temporal lobe with adjacent subarachnoid and subdural haemorrhage. Neoplasia with haemorrhage was in the differential but was later excluded on repeat imaging. Serum ANCA was positive, with a proteinase-3 antibody level of 30 (0 – 2 normal range). She was treated with antiseizure medication and underwent a repeat MRI head after three months, which showed a marked resolution of the haemorrhagic contusion. This case underscores the need for awareness of potential neurological complications from recreational drug use.