Neurotoxic and cardiotoxic effects of cocaine and ethanol.
BACKGROUND
Concurrent abuse of alcohol and cocaine results in the formation of cocaethylene, a powerful cocaine metabolite. Cocaethylene potentiates the direct cardiotoxic and indirect neurotoxic effects of cocaine or alcohol alone.


METHODS
A 44-year-old female with history of cocaine and alcohol abuse presented with massive stroke in the emergency department. CT scan revealed extensive left internal carotid artery dissection extending into the left middle and anterior cerebral arteries resulting in a massive left hemispheric infarct, requiring urgent decompressive craniectomy. The patient had a stormy hospital course with multiple episodes of torsades de pointes in the first 4 days requiring aggressive management. She survived all events and was discharged to a nursing home with residual right hemiplegia and aphasia.


CONCLUSIONS
The combination of ethanol and cocaine has been associated with a significant increase in the incidence of neurological and cardiac emergencies including cerebral infarction, intracranial hemorrhage, myocardial infarction, cardiomyopathy, and cardiac arrhythmias. The alteration of cocaine pharmacokinetics and the formation of cocaethylene have been implicated, at least partially, in the increased toxicity of this drug combination.
Farooq
Muhammad U
MU
Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
Bhatt
Archit
A
Patel
Mehul
M
D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001037:Aphasia / Q000209:etiology; D001921:Brain / Q000473:pathology; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003042:Cocaine / Q000031:analogs & derivatives / Q000378:metabolism; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D003131:Combined Modality Therapy; D003399:Craniotomy; D019299:Decompression, Surgical; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage; D018810:Magnetic Resonance Angiography; D014057:Tomography, X-Ray Computed; D016171:Torsades de Pointes / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D008278:Magnesium Sulfate; C066444:cocaethylene; D003042:Cocaine