It said in there that it was a good recovery, which for being bilateral lesions affecting a large portion of their brain, is pretty freaking lucky. I would have expected very little recovery and a lifetime of disability. I’m a pessimist when I see this stuff though, too many bad cases in the past.

This complication of cocaine use generally manifests as a single episode of demyelination that recovers well with treatment. Of course, the long term depends on how often the cocaine abuse happens.

Thank you for this comment, because it brings up some very important issues, which I hope this reply addresses.

The biggest issue is the matter of patient confidentiality. This is of utmost concern in an online medical community, especially one wherein clinical vignettes are presented. I take extreme care to avoid including any information that can narrow down to a patient, thus breaching confidentiality. Similarly, I expect anyone else commenting or posting here to follow this rule, Rule 4, which was created not just for internet etiquette but literally to prevent illegal breaches of confidentiality. With regards to consent - this is not required for publishing de-identified information, or sites like Radiopaedia with their thousands of cases would not exist. With regards to patient confidential information that cannot be shared - this not only includes the obvious ones such as patient age, DOB, dates of events, addresses, etc etc, but also vaguer information. For example, there are cases that I would never present here online because the disease is so incredibly rare that the disease itself becomes a patient identifier. These types of cases I would formally publish in the literature if need be. For this particular case, I do not think the information presented breaks these rules (or I would not have posted). Cocaine use is fairly common among the demographic in question, and being found in the shower is not that uncommon, although dramatic.

Second, to address the following:

The title is like your a friend but the text is from a medical professional.

This is something that I have been struggling with. This community is growing at an exceptional rate, and visitors seem to be overwhelmingly from a non-medical background. There are comments that frankly say they do not understand certain things, and other comments and questions imply a lack of experience with looking at imaging studies. I have been vacillating between using terminology and sentences that laypeople can understand versus maintaining medical terminology. I think this is why you think I am writing about a friend in the title, but the body of the post is more medically-oriented. For this reason, I have changed the title - it did not need to be so dramatic. In the future, I will be more careful with my wording.

Please let me know if this addresses your concerns. I would also love to hear more input regarding point #2. Should I continue to word cases as if talking to other medical professionals or include more basic terminology so that the general public can understand? The purpose of these cases, and this community in general, is to be an educational resource in terms of what Radiology is and does.

[The person whose brain you are looking at was] found by [his or her] roomate in the shower, mute and diaphretic, after missing work.

There’s no real private information here. Young adult working with finance testing positive for cocaine? Sure, that narrows it down. If medical professionals weren’t allowed to talk about their experiences even when anonymized we would still be in the middle ages in terms of medicine.