Progressive neuropsychiatric impairment complicated by recent cerebral infarction possibly associated with chronic tiletamine misuse: a case report

Objective This study reports a case of progressive neuropsychiatric impairment complicated by recent cerebral infarction in a young male with no major traditional cerebrovascular risk factors other than long-term smoking, following chronic intranasal misuse of a veterinary tiletamine-zolazepam compound preparation. We explore its clinical features, multidisciplinary management, and possible pathophysiological mechanisms linking it to cerebrovascular events. Methods Clinical data, including history, examinations, diagnosis, treatment, and prognosis, were retrospectively analyzed and interpreted with the existing literature. Results The patient was a 32-year-old male with a two-year history of intranasal administration of a veterinary tiletamine-containing product that escalated from intermittent to daily use and was hospitalized for progressive cerebellar ataxia, limb tremor, dysarthria, and depressed mood accompanied by suicidal ideation. Following a comprehensive evaluation, common etiologies of stroke in young adults, including arterial dissection and cardiogenic embolism, were not identified on the available workup; however, prolonged cardiac rhythm monitoring, thrombophilia screening, and autoimmune serology were not performed, and a paroxysmal arrhythmic or hypercoagulable source cannot be entirely excluded. A diagnosis of recent cerebral infarction was established on neuroimaging. Management spanned two hospitalizations: withdrawal control, neuroprotection, mood stabilization, and secondary stroke prevention were initiated during the first (psychiatric) admission; nine days after discharge, neurological worsening following relapse to tiletamine use and poor medication adherence prompted a second (neurological) admission, where cerebral angiography was completed and the regimen continued, leading to marked improvement. At the 3-month follow-up, the patient reported no further non-medical use of tiletamine or other recreational drugs since the second discharge; his smoking and alcohol use during the follow-up period were not systematically assessed. Conclusion To our knowledge, this represents the first reported case of recent cerebral infarction possibly associated with chronic tiletamine misuse in a young adult. This case is hypothesis-generating: it raises the possibility that chronic tiletamine misuse may have contributed to cerebrovascular injury and cerebral infarction in this patient; however, given the single-case design, the self-reported exposure history, and the presence of coexisting confounding factors, a definitive causal relationship cannot be established. These findings may inform the clinical management of novel psychoactive substance misuse and public health regulation.