Neurovascular Complications of Cocaine Use at a Tertiary Stroke Center

Objective: An association between cocaine use and stroke has been reported, but few studies have examined cocaine-related neurovascular disease using modern stroke diagnostic techniques. We describe a large cohort of patients with cocaine-related stroke to define the pathophysiology and manifestations of cocaine-related neurovascular disease. Methods: All adult admissions to a tertiary neurovascular service from July 1, 1998 to July I, 2008 were screened for evidence of current or previous cocaine use. Patients included underwent thorough review of medical records including diagnostic procedure, laboratory, and imaging results. Results: A total of 5142 records were screened and 96 patients were identified; 45 (47%) were given the diagnosis of ischemic stroke/transient ischemic attack (TIA), 26 (27%) with intracerebral hemorrhage (ICH), and 25 (26%) with subarachnoid hemorrhage. In all, 61(63.5%) patients were categorized as active and 35 (36.5%) as previous cocaine users. Stroke type differed significantly between active and prior users (P = .004), with active users more likely to have ICH compared with previous users (37.7% v 8.6%) and less likely to have ischemic stroke or TIA (36.1% v 65.7%). The most common stroke/TIA cause was large artery atherosclerosis in 20 (44%) patients. Of the 25 subarachnoid hemorrhage cases, 22 (88%) were aneurysmal. Conclusion: Ischemic stroke/TIA is a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease; neither vasculitis nor vasospasm was a common cause of stroke in this cohort. ICH is more common in those currently using cocaine perhaps because of acute spikes in blood pressure. Further prospective trials are needed to confirm these results.