TY - JOUR
T1 - Cerebrovascular complications of the use of the crack form of alkaloidal cocaine
AU - Levine, Steven R.
AU - Brust, John C.m.
AU - Futrell, Nancy
AU - Ho, K. L.
AU - Blake, David
AU - Millikan, Clark H.
AU - Brass, Lawrence M.
AU - Fayad, Pierre
AU - Schultz, Lonni R.
AU - Selwa, James F.
AU - Welch, K. M.A.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1990/9/13
Y1 - 1990/9/13
N2 - Background and Methods. The use of cocaine, especially one of its alkaloidal forms (“crack”), has been increasingly associated with cerebrovascular disease. To clarify the clinical, radiologic, and pathological features of the events associated with cocaine use, we identified 28 patients at four medical centers who had stroke temporally related to the use of alkaloidal cocaine (during or within 72 hours of use). Result. The 28 patients had the following types of cerebrovascular event: cerebral infarction (n = 18[2hemorrhagic; 1 fatal]) in the areas supplied by the middle cerebral artery (n = 10), anterior cerebral artery (n = 3), posterior cerebral artery (n = 1), and vertebrobasilar arteries (n = 4); subarachnoid hemorrhage (n = 5); intraparenchymal hemorrhage (n = 4); and primary intraventricular hemorrhage (n = 1). Eighteen patients (64 percent) had acute neurologic symptoms immediately or within one hour of using cocaine. Fifteen patients (45 percent) with either occlusive or hemorrhagic strokes had severe headache as an early symptom. Vasculitis was not suggested by radiography in any patient, nor was it identified on pathological examination in one patient who died. All the patients were young (mean age, 34 years; range, 23 to 49) and had no other apparent, direct cause of stroke. Other risk factors for stroke among the patients included mild mitral-valve prolapse (n = 4), hypertension (n = 4), cigarette smoking (n = 8), and regular alcohol use (n = 6). There is a strong temporal association of the use of alkaloidal cocaine with both ischemic and hemorrhagic cerebrovascular events. Cocaine-related stroke probably has many causes. A thorough history focusing on the use of cocaine and toxicologic screening of urine and serum should be part of the evaluation of any young patient with a stroke. (N Engl J Med 1990; 323:699–704).
AB - Background and Methods. The use of cocaine, especially one of its alkaloidal forms (“crack”), has been increasingly associated with cerebrovascular disease. To clarify the clinical, radiologic, and pathological features of the events associated with cocaine use, we identified 28 patients at four medical centers who had stroke temporally related to the use of alkaloidal cocaine (during or within 72 hours of use). Result. The 28 patients had the following types of cerebrovascular event: cerebral infarction (n = 18[2hemorrhagic; 1 fatal]) in the areas supplied by the middle cerebral artery (n = 10), anterior cerebral artery (n = 3), posterior cerebral artery (n = 1), and vertebrobasilar arteries (n = 4); subarachnoid hemorrhage (n = 5); intraparenchymal hemorrhage (n = 4); and primary intraventricular hemorrhage (n = 1). Eighteen patients (64 percent) had acute neurologic symptoms immediately or within one hour of using cocaine. Fifteen patients (45 percent) with either occlusive or hemorrhagic strokes had severe headache as an early symptom. Vasculitis was not suggested by radiography in any patient, nor was it identified on pathological examination in one patient who died. All the patients were young (mean age, 34 years; range, 23 to 49) and had no other apparent, direct cause of stroke. Other risk factors for stroke among the patients included mild mitral-valve prolapse (n = 4), hypertension (n = 4), cigarette smoking (n = 8), and regular alcohol use (n = 6). There is a strong temporal association of the use of alkaloidal cocaine with both ischemic and hemorrhagic cerebrovascular events. Cocaine-related stroke probably has many causes. A thorough history focusing on the use of cocaine and toxicologic screening of urine and serum should be part of the evaluation of any young patient with a stroke. (N Engl J Med 1990; 323:699–704).
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U2 - 10.1056/NEJM199009133231102
DO - 10.1056/NEJM199009133231102
M3 - Article
C2 - 2388668
AN - SCOPUS:0025102026
VL - 323
SP - 699
EP - 704
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 11
ER -