Neurovascular Complications of Cocaine Use at a Tertiary Stroke Center

Toossi, Shahed; Hess, Christopher P.; Hills, Nancy K.; Josephson, S. Andrew

doi:10.1016/j.jstrokecerebrovasdis.2009.05.002

Cited by 71 publications

(62 citation statements)

References 28 publications

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“…[29][30][31] Among cocaine users, ischemic stroke, and TIA related to large vessel atherosclerosis are the most common neurovascular events in former users, whereas ICH is more common in acute/current users. 32 In a series of 96 cocaine users, neither vasospasm nor vasculitis was a common cause of stroke in this cohort. 32 A less well-established risk factor is low serum cholesterol.…”

Section: Introductionmentioning

confidence: 69%

“…32 In a series of 96 cocaine users, neither vasospasm nor vasculitis was a common cause of stroke in this cohort. 32 A less well-established risk factor is low serum cholesterol. The Heart Protection Study (HPS) 33 and the High-dose Atorvastatin after Stroke of Transient Ischemic Attack (SPAR-CLE) 34 trials reported higher rates of ICH in participants assigned to statin treatment.…”

Section: Introductionmentioning

confidence: 69%

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Update in Intracerebral Hemorrhage

Aguilar

Brott

2011

The Neurohospitalist

124

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Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is defined as bleeding within the brain parenchyma. Intracranial hemorrhage includes bleeding within the cranial vault and encompasses ICH, subdural hematoma, epidural bleeds, and subarachnoid hemorrhage (SAH). This review will focus only on ICH. This stroke subtype accounts for about 10% of all strokes. The hematoma locations are deep or ganglionic, lobar, cerebellar, and brain stem in descending order of frequency. Intracerebral hemorrhage occurs twice as common as SAH and is equally as deadly. Risk factors for ICH include hypertension, cerebral amyloid angiopathy, advanced age, antithrombotic therapy and history of cerebrovascular disease. The clinical presentation is ''stroke like'' with sudden onset of focal neurological deficits. Noncontrast head computerized tomography (CT) scan is the standard diagnostic tool. However, newer neuroimaging techniques have improved the diagnostic yield in terms of underlying pathophysiology and may aid in prognosis. Intracerebral hemorrhage is a neurological emergency. Medical care begins with stabilization of airway, breathing function, and circulation (ABCs), followed by specific measures aimed to decrease secondary neurological damage and to prevent both medical and neurological complications. Reversal of coagulopathy when present is of the essence. Blood pressure management can be key and continues as an area of debate and ongoing research. Surgical evacuation of ICH is of unproven benefit though a subset of well-selected patients may have improved outcomes. Ventriculostomy and intracranial pressure (ICP) monitoring are interventions also used in this patient population. To date, hemostatic medications and neuroprotectants have failed to result in clinical improvement. A multidisciplinary approach is recommended, with participation of vascular neurology, vascular neurosurgery, critical care, and rehabilitation medicine as the main players.

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Section: Introductionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 69%

Update in Intracerebral Hemorrhage

Aguilar

Brott

2011

The Neurohospitalist

124

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“…87 An analysis of 96 cocaine users hospitalized with stroke reported that stroke type differed between current cocaine users, former cocaine users, and the general population, with a higher proportion of hemorrhagic strokes in cocaine users (Table 6). 88 Of cocaine users with ischemic strokes, 44% were due to large-artery atherosclerosis, 11% to cardioemboli, and 22% to small-vessel occlusion. 88 Acute spikes in blood pressure likely contribute to hemorrhagic strokes, especially among current cocaine users.…”

Section: Strokementioning

confidence: 99%

Cardiovascular Effects of Cocaine

2010

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“…Los AVC asociados al uso de cocaína se presentan en proporción relativamente similar entre isquémicos y hemorrágicos 25 . De los AVC de tipo isquémico, alrededor de 50% son secundarios a oclusión trombótica de arterias grandes y el resto a fenómenos embólicos y oclusión de vasos pequeños probablemente por vasculitis 26 .…”

Section: Diagnóstico Y Manejo De Los Eventos Isquémicosunclassified