Recurrent embolic stroke and cocaine-related cardiomyopathy.
Ischemic stroke temporally related to cocaine abuse has become increasingly common in young adults. Despite this relation, however, the pathogenesis of infarction in many of these patients remains obscure. I report the case of a 39-year-old man who developed occlusion of the frontopolar branches of the left middle cerebral artery 1 hour after intravenous cocaine use. Eleven days later he developed occlusion of the superior division of the right middle cerebral artery. In this case the mechanism of infarction was clearly cardiogenic embolization. Chest radiograph and echocardiogram revealed dilated cardiomyopathy with left ventricular thrombi. No cause other than cocaine abuse was found for his cardiomyopathy. This is the second reported case of cocaine-related cardiomyopathy presenting as embolic stroke and associated with intracavitary thrombus. Such an association may be more common than previously thought. Thorough cardiac evaluation in all patients with ischemic stroke related to cocaine abuse is appropriate.
Department of Neurology, University of Tennessee, College of Medicine, Memphis.
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Sauer
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D003042:Cocaine; D004452:Echocardiography; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D012008:Recurrence; D019966:Substance-Related Disorders / Q000150:complications*; D014057:Tomography, X-Ray Computed
D003042:Cocaine