Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study.
OBJECTIVE
To determine the incidence of cocaine abuse in cases of fatal intracranial hemorrhage and to examine potential pathophysiologic mechanisms.


METHODS
Prospective clinical, autopsy, and toxicologic evaluation of all cases of fatal non-traumatic intracranial hemorrhage examined during 1 year (April 11, 1989 to April 10, 1990) at the Connecticut Office of the Chief Medical Examiner. Autopsy examination included exhaustive histologic evaluation of cerebral vessels and parenchyma for vasculitis and other vasculopathies.


RESULTS
Ten of 17 (59%) of all non-traumatic intracranial hemorrhages were associated with a positive toxicology for cocaine. Seven (70%) of these were parenchymal hemorrhages, and the remaining three (30%) were subarachnoid hemorrhages (ruptured berry aneurysms). No vasculitis or other vasculopathy was identified.


CONCLUSIONS
These findings implicate cocaine use as a significant risk factor for fatal brain hemorrhage and may explain, in part, the increased incidence of hemorrhagic stroke in some drug-using cohorts. The lack of specific pathologic findings suggests that cocaine-associated intracranial hemorrhages are a consequence of the pharmacodynamic effect of cocaine and not a cocaine-induced vasculopathy.
Nolte
K B
KB
Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque 87131-5091, USA.
Brass
L M
LM
Fletterick
C F
CF
D000328:Adult; D001344:Autopsy; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D003042:Cocaine / Q000652:urine; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000473:pathology*
D003042:Cocaine