title: Cocaine-induced intracerebral hemorrhage in a patient with cerebral amyloid angiopathy.
abstract: Intracerebral hemorrhage (ICH) is a well-recognized complication of recreational cocaine use. The precise mechanism of the cocaine-induced hemorrhagic event is unclear, although multiple factors have been implicated. We report a case of a 62-year-old woman who suffered left parieto-occipital ICH with herniation and death, following a cocaine binge. Microscopic examination also revealed extensive cerebral amyloid angiopathy (CAA) in the vicinity of the hemorrhage. We additionally studied brain tissue in eight subjects between ages of 60 and 80 who were positive for cocaine metabolites at autopsy; of these, none had vascular amyloid-β deposits by immunohistochemistry. Whereas we found no evidence that chronic cocaine use is a risk factor for CAA, given the age-associated nature of CAA and the aging population using cocaine, CAA-induced hemorrhage in the setting of cocaine use may be more common than recognized. This is the first reported case of CAA-associated ICH precipitated by cocaine.
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, NY, USA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Shvartsbeyn
authors.forename: Daniel G K
authors.initials: DG
authors.lastname: Phillips
authors.forename: Michael A
authors.initials: MA
authors.lastname: Markey
authors.forename: Alan
authors.initials: A
authors.lastname: Morrison
authors.forename: Joyce L
authors.initials: JL
authors.lastname: DeJong
authors.forename: Rudy J
authors.initials: RJ
authors.lastname: Castellani
mesh_terms: D016657:Cerebral Amyloid Angiopathy / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000473:pathology; D003042:Cocaine / Q000009:adverse effects*; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects*; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D008875:Middle Aged
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine