The neurovascular complications of cocaine.
BACKGROUND
Cocaine use has been temporally associated with neurovascular complications, including the rupture of intracerebral aneurysms. The purpose of the current study was to determine the type of neurovascular complications associated with cocaine use in our patient population, the temporal relationship between cocaine use and their onset, and whether cocaine users with subarachnoid hemorrhage (SAH) presented with smaller aneurysms at an earlier age than a control group of noncocaine users with SAH.


METHODS
Thirty-three patients who presented to the Detroit Medical Center with neurovascular sequelae associated with cocaine use were identified. All patients were chronic cocaine users who related a history of recent use confirmed by a drug screen. Cocaine users with SAH were compared to a control group of 44 patients with SAH who presented without evidence of cocaine use.


RESULTS
Sixteen patients presented with SAH. Twelve patients subsequently underwent four-vessel cerebral arteriogram revealing 14 aneurysms; six patients presented with intracerebral hemorrhage (ICH) and seven patients with evidence of ischemic stroke. Eighteen (54.5%) patients noted onset of their symptoms while using cocaine, 87.9% noted onset within 6 hours of use. Delayed presentation occurred predominantly in patients who suffered ischemic strokes. The average age of patients who used cocaine and presented with SAH secondary to a ruptured intracerebral aneurysm was 32.8 years with an average aneurysm diameter of 4.9 mm versus an average age of 52.2 years with an average aneurysm diameter of approximately 11.0 mm in noncocaine users. Population differences were statistically significant at the p < 0.05 level. Mortality was 27.3% for patients who presented with neurovascular sequelae of their cocaine use, with 77.8% of deaths occurring in patients who presented with SAH.


CONCLUSIONS
Chronic cocaine use appears to predispose patients who harbor incidental neurovascular anomalies to present at an earlier point in their natural history than similar non-cocaine users.
Fessler
R D
RD
Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI 48202, USA.
Esshaki
C M
CM
Stankewitz
R C
RC
Johnson
R R
RR
Diaz
F G
FG
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D002533:Cerebral Angiography; D003042:Cocaine; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D002538:Intracranial Arteriovenous Malformations / Q000150:complications; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D003042:Cocaine