title: Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH). This study analyzes the impact of cocaine use on patient presentation, complications, and outcomes.
  
  
  METHODS
  Data of patients admitted with aSAH between 1991 and 2009 were reviewed to determine impact of acute cocaine use (C). These patients were compared with aSAH patients without recent cocaine exposure (NC) in relation to their presentation, complications such as aneurysmal rerupture and delayed cerebral ischemia, and outcomes including hospital mortality and functional outcome.
  
  
  RESULTS
  Data of 1134 aSAH patients were reviewed; 142 patients (12.5%) had associated cocaine use. Cocaine users were more likely to be younger (mean age: C, 49±11; NC, 53±14; P<0.001). There were no differences in rates of poor-grade Hunt and Hess (4-5); (C, 21%; NC, 26%; P>0.05), associated intraventricular hemorrhage (C, 56%; NC, 51%; P>0.05), or hydrocephalus on admission Head CT (C, 49%; NC, 52%; P>0.05). Aneurysm rerupture incidence was higher among cocaine users (C, 7.7%; NC, 2.7%; P<0.05). The association of cocaine use with higher risk of delayed cerebral ischemia (C, 22%; NC, 16%; P<0.05) was not significant after correcting for other factors. Cocaine users were less likely to survive hospitalization compared with nonusers (mortality: C, 26%; NC, 17%; P<0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users (P<0.001). There were no differences in functional outcomes between the 2 groups.
  
  
  CONCLUSIONS
  Acute cocaine use was associated with a higher risk of aneurysm rerupture and hospital mortality after aSAH.
authors: Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors: Tiffany R
authors: TR
authors: Chang
authors: Robert G
authors: RG
authors: Kowalski
authors: Filissa
authors: F
authors: Caserta
authors: Juan Ricardo
authors: JR
authors: Carhuapoma
authors: Rafael J
authors: RJ
authors: Tamargo
authors: Neeraj S
authors: NS
authors: Naval
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000401:mortality; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000401:mortality; D014057:Tomography, X-Ray Computed
keywords: aneurysm; cocaine; mortality; outcome; subarachnoid hemorrhage; vasospasm