Causes and Risks: Cocaine is a product of the coca plant and is a well-known drug involved in illicit (illegal or not medically prescribed) drug use. It is not a narcotic drug. It is a stimulant, causing increased activity of the central nervous system (associated with the brain and spinal cord) and the peripheral nervous system (the rest of the body). It is taken into the body in several forms, such as by smoking, snorting, ingesting (eating), or injecting. The amount required to produce an effect varies with the individual, with the purity of the drug, and with the means of taking it into the body. A smaller amount is usually required with injection into a vein or with smoking.
Use of cocaine has been associated with many medical conditions, including cardiovascular (heart and blood vessel) collapse, irregular heartbeats, heart attack, lung damage, damage to a fetus, and very high temperature elevations. Cocaine also causes mood swings, delirium, migraine-type headaches, seizures, transient ischemic attacks (TIA), and strokes. Stroke secondary to cocaine probably occurs because cocaine causes blood vessels to constrict (narrow) with an associated increase in blood pressure (hypertension). The vasoconstriction can be severe enough to reduce or block blood flow through the arteries in the brain.
Stroke secondary to cocaine is most common in men under 40 years old. Risks include a history of recent cocaine use. In a few people who experience stroke after using cocaine, an underlying arteriovenous malformation is found, which may have predisposed them to stroke. In these cases the stroke is due to bleeding in the brain as opposed to decreased blood flow.
Prevention: Avoid illicit use of cocaine.
Symptoms: See Stroke
Signs and Tests: A medical history of symptoms and history of cocaine use, if known, are important in the diagnosis by the health care provider. Symptoms indicating cocaine use may include nosebleeds, headache, fatigue, inability to sleep, anxiety, depression, chronic hoarseness, or restlessness. Maximum neurologic deficits commonly are present at the beginning (onset) of stroke caused by cocaine.
An examination may include neurologic, motor, and sensory testing to determine the specific neurologic deficits present, because they often correspond closely to the location of the injury to the brain. Examination may show changes in vision or visual fields, changes in reflexes including abnormal reflexes or abnormal extent of "normal" reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.
Signs of other disorders associated with the use of cocaine may be present (cardiovascular collapse, irregular heartbeats, heart attack, lung damage, and others).
Urine or blood toxicology screen may be positive, confirming cocaine use.
Treatment: Treatment of stroke secondary to cocaine may be complicated by the need to treat the stroke, other disorders that may occur from the use of cocaine, and the need to treat any symptoms of withdrawal from cocaine.
The person may be in a coma. There may be a need for life support, including placement of tubes into the airway and artificial ventilation (breathing assistance, breathing machines).
All use of cocaine must be stopped.
Heart arrhythmias (irregular beats) are treated with antiarrhythmic drugs or other medications.
Other conditions should be treated as appropriate.
The person should be continually observed for signs of cocaine withdrawal. Dopamine agonist medications may reduce symptoms of withdrawal from cocaine. Sedatives such as diazepam and midazolam may be of some benefit in reducing symptoms of withdrawal.
Prognosis: The outcome varies, depending on the severity of the stroke, any other conditions that may be present because of the use of cocaine, presence of withdrawal symptoms, and other factors. It is often poor, with death caused by collapse of multiple body systems.
Complications: See Stroke.
Go to the emergency room or call the local emergency number (such as 911) if symptoms of stroke secondary to cocaine occur.
