Cerebrovascular Complications of the Use of the Crack Form of Alkaloidal Cocaine

Levine, Steven R.; Brust, John C.M.; Futrell, Nancy; Ho, Khang-Loon; Blake, David; Millikan, Clark H.; Brass, Lawrence M.; Fayad, Pierre; Schultz, Lonni; Selwa, James F.; Welch, K. M. A.

doi:10.1056/nejm199009133231102

Cited by 344 publications

(127 citation statements)

References 48 publications

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“…Reperfusion hemorrhages from an ischemic stroke can also occur, and the risk of hemorrhage increases with the concomitant use of alcohol. 26 While the pathomechanism of hemorrhagic stroke is straightforward, the causes for ischemic stroke are manifold, including cocaine-induced vasoconstriction, vasculitis (due to unknown additives/impurities), vasospasm, or the direct effects of cocaine on hemostasis. Cocaine enhances the responses of platelets to arachidonic acid, with increased levels of thromboxane, which leads to increased platelet aggregation resulting in concurrent myocardial and cerebral infarction from thrombosis.…”

Section: Cocainementioning

confidence: 99%

Addictive Illegal Drugs: Structural Neuroimaging

Geibprasert¹,

Gallucci²,

Krings³

2009

AJNR Am J Neuroradiol

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SUMMARY:Illegal addictive drugs can lead to functional or structural impairment of the central nervous system. This review provides an overview of the structural imaging findings on CT, MR imaging, and conventional angiography related to chronic and acute abuse of the most commonly abused illegal drugs, including cannabis, organic solvents, and amphetamines and opioids and their respective derivatives. Pathomechanisms include excitotoxicity, which may lead to an acute or subacute leukoencephalopathy, and vascular complications, including vasoconstriction, vasculitis, or hypertension, which may lead to intracranial hemorrhage or ischemia. Because clinical findings alone are often nonspecific, and afflicted patients are unlikely to admit to the substance abuse, the neuroradiologist may play an important role in establishing the diagnosis and, thereby, initiating treatment.ABBREVIATIONS: CB ϭ cannabinoid; 5-HT ϭ serotonin (5-hydroxytryptamine); MCA ϭ middle cerebral artery; MDMA ϭ 3,4-methylenedioxymethamphetamine; MRA ϭ MR angiography; PET ϭ positron-emission tomography

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Section: Cocainementioning

confidence: 99%

Addictive Illegal Drugs: Structural Neuroimaging

Geibprasert¹,

Gallucci²,

Krings³

2009

AJNR Am J Neuroradiol

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Both ischemic and hemorrhagic neurovascular sequelae have been associated with the alkaloid ("crack") form of cocaine, whereas cocaine hydrochloride has generally been associated only with intracranial hemorrhage. 4 The association between cocaine use and aneurysmal SAH (aSAH) has previously been analyzed in several studies.…”

mentioning

confidence: 99%

Cocaine Use Is an Independent Risk Factor for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Conway

Tamargo

2001

Stroke

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Background and Purpose-Although acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH), the prevalence of vasospasm and the clinical outcome of patients experiencing aSAH associated with cocaine exposure are unclear. We have analyzed this patient population in our institution to address these issues. Methods-Between 1992 and 1999, 440 patients presented to our institution with aSAH. This sample was retrospectively analyzed to determine which patients had used cocaine within 72 hours of aSAH as documented by urine toxicology studies or patient history. These patients were then compared with control aSAH patients without recent cocaine exposure through univariable and multivariable analyses. Results-Twenty-seven aSAH patients (6.1% of total) had either urine toxicology positive for cocaine metabolites (20 patients, 74%) or a history of cocaine use within 72 hours of aSAH (7 patients, 26%). Cocaine users were more likely to experience cerebral vasospasm defined as a delayed clinical deficit (from 3 to 16 days after aSAH) unexplained by concurrent CT scan and either responsive to hypervolemic and/or hypertensive therapy or accompanied by angiographic confirmation of vessel narrowing than control subjects (63% versus 30%; odds ratio [OR], 3.90; 95% confidence interval [CI], 1.77 to 8.62; Pϭ0.001). Patients using cocaine were younger than control subjects (mean age, 36 versus 52 years; PϽ0.0001). Aneurysms of the anterior circulation were observed more frequently in cocaine users than in control subjects (97% versus 84%; OR, 6.89; 95% CI, 1.18 to 47.47; Pϭ0.029). A significant difference was not observed, however, in the discharge Glasgow Outcome Scale (GOS) scores between the 2 groups (Pϭ0.73). Differences were not observed between the 2 groups when the distributions of sex, hypertension, admission Glasgow Coma Scale subarachnoid hemorrhage grade, and multiple aneurysms were analyzed. Logistic regression models identified variables independently associated with vasospasm and discharge GOS score. Only a thick blood clot on the admission CT (OR, 7.46; 95% CI, 3.95 to 14.08; PϽ0.0001) and recent cocaine use (OR, 6.41; 95% CI, 2.14 to 19.23; Pϭ0.0009) were independently associated with vasospasm. Cocaine use was not independently associated with the discharge GOS score. Conclusions-We conclude that there is an increased prevalence of vasospasm in aSAH patients with recent cocaine exposure but no difference in clinical outcome. In addition, these patients are younger and more likely to have anterior circulation aneurysms.

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“…En cuanto al momento de presentación de dichas complicaciones cerebro-vasculares tras el consumo de dicha sustancia, si bien pueden ocurrir tardíamente, en la mayoría de los pacientes se presentan dentro de las primeras horas posteriores al consumo [6,13]. En algunos trabajos como el de Fessler se afirma que el 54% de los pacientes presentó la sintomatología mientras consumía la droga, el 33% dentro de las primeras seis horas, el 6% entre seis y doce horas y el 3% entre 12 y 24 horas posteriores al consumo [7].…”

Section: Discussionunclassified

Patología cerebro-vascular hemorrágica en adultos asociada al consumo de cocaína

et al. 2005

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RESUMENLa cocaína es la segunda droga de comercio ilegal más consumida en España después del cannabis. El número de pacientes atendidos en los servicios de urgencias tras consumir cocaína y los casos de muerte secundarios al consumo de la misma han ido aumentando hasta multiplicarse por seis en los últimos años. El consumo de este alcaloide ocasiona efectos nocivos, constatados sobre diferentes órganos y sistemas corporales, e incluso la muerte. A nivel del SNC destaca, por su gravedad e incidencia, la patología cerebro-vascular hemorrágica (PCVH). Este tipo de cuadro se halla asociado al consumo de drogas ilícitas entre el 9,5% y el 34% de los accidentes vasculares en menores de 45 años, siendo la cocaína la más frecuentemente implicada en su presentación. Por otro lado, la rotura de un aneurisma o malformación arteriovenosa se ha detectado hasta en el 50% de los pacientes con PCVH secundarios al consumo de cocaína. Presentamos tres casos de muerte súbita en adultos por patología cerebro-vascular hemorrágica asociada al consumo de cocaína.Palabras clave: Muerte súbita, patología cerebro-vascular, hemorragia, cocaína. Cuad Med Forense 2005; 11(41):221-228 ABSTRACTCocaine is the second most frequent illegal drug consumed in Spain after cannabis. A significant increase has occurred in the number of individuals treated in emergency departments after cocaine use just as in the number of cocaine-related deaths. These rates have been actually multiplied by six in the latest years. Cocaine causes injury in different organ systems, even death. In the CNS the use of cocaine is frequently associated with cerebral haemorrhage. Stroke in young adults below 45 years is usually related to drug use between 9,5% and 34% of cases, and cocaine is the most frequently mentioned drug. Otherwise, even 50% of cocainerelated stroke is the result of rupture of saccular aneurysms involving the arteries at the base of the brain and vascular malformation. In this paper, we present three cases of sudden death in adults due to cerebral haemorrhage associated with cocaine use.

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Cerebrovascular Complications of the Use of the Crack Form of Alkaloidal Cocaine

Cited by 344 publications

References 48 publications

Addictive Illegal Drugs: Structural Neuroimaging

Addictive Illegal Drugs: Structural Neuroimaging

Cocaine Use Is an Independent Risk Factor for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Patología cerebro-vascular hemorrágica en adultos asociada al consumo de cocaína

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