Orbital infarction after cocaine use

Abstract

A 36-year-old, right-handed woman attended a party, during which she consumed alcohol and inhaled cocaine and heroin through both nostrils. She lost consciousness at 7 am. Her head was positioned down, with her left face and orbit pressed against a desk. She awoke 3 hours later noting severe left orbital pain and was unable to elevate her left eyelid. When her eyelid was manually elevated, she noted complete visual loss in the left eye. Medical history was remarkable for polysubstance abuse (alcohol, heroin, and cocaine sniffing; she denied IV drug use), bronchial asthma, and bipolar disorder. She presented to a local emergency room. An emergent MRI/MRA/magnetic resonance venography (MRV) was obtained. The brain MRA and MRV were normal, but the fat-suppressed orbital MRI showed diffuse swelling of all extraocular muscles in the left orbit, but no abnormal orbital enhancement. The patient was transferred to …