Tiletamine is a dissociative anesthetic used in veterinary medicine and has recently emerged as a potential illicit additive in e-cigarettes after regulation of etomidate. However, reports of chronic tiletamine-containing e-cigarette use remain scarce. We report the case of a 22-year-old man who developed progressive gait instability, dysarthria, choking on drinking, hand tremor, emotional instability, and marked craving after chronic use of tiletamine-containing e-cigarettes. Brain MRI and rout