title: Emergence of recreational drug abuse as a major risk factor for stroke in young adults.
abstract: OBJECTIVE
  To investigate the clinical and epidemiologic relations between recreational drug abuse and stroke in young persons.
  
  
  METHODS
  A case-control study based on medical records.
  
  
  METHODS
  San Francisco General Hospital, a 400-bed municipal hospital.
  
  
  METHODS
  Consecutive sample of 214 patients aged 15 to 44 years, admitted between 1979 and 1988 with a diagnosis of ischemic or hemorrhagic stroke. An equal number of control patients admitted with diagnoses of status asthmaticus, acute appendicitis, or acute cholecystitis were matched to stroke patients by age, sex, and year of hospitalization.
  
  
  RESULTS
  Seventy-three patients with stroke (34%) were drug abusers compared with 18 (8%) of the controls. In 47 patients with stroke, temporal proximity of drug administration (n = 34) or infectious endocarditis (n = 13) suggested a direct association between drug abuse and stroke. After controlling for other identifiable stroke risk factors, the estimated relative risk for stroke among drug abusers compared with that among non-drug abusers was 6.5 (95% CI, 3.1 to 13.6), and this increased to 49.4 (CI, 6.4 to 379.0) for those patients whose symptoms began within 6 hours of drug administration. Among patients less than 35 years of age, drug abuse was the most commonly identified potential predisposing condition (47%), and it was the only condition with a significantly elevated relative risk for stroke (11.7; CI, 3.2 to 42.5). Further, a substantial rise in the proportion of drug-related strokes was observed in the last 3 years of the study (31% in 1986 to 1988, compared with 15% in 1979 to 1985, P = 0.008). Cocaine, especially recently, was the drug used most frequently in drug-related strokes.
  
  
  CONCLUSIONS
  In an urban population such as ours, recreational drug abuse appears to be a prominent and growing risk factor for strokes in young adults.
authors.affiliation: Stanford University School of Medicine, California.
authors.forename: D A
authors.initials: DA
authors.lastname: Kaku
authors.forename: D H
authors.initials: DH
authors.lastname: Lowenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000661:Amphetamine / Q000009:adverse effects; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D003042:Cocaine / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology
chemical_list: D000661:Amphetamine; D003042:Cocaine