Moyamoya-like vasculopathy from cocaine dependency.

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Moyamoya vasculopathy is a rare, progressive cerebrovascular disorder characterized by stenosis of the terminal internal carotid arteries and the development of collateral circulation.
• Cocaine, particularly alkaloidal cocaine, is a known neurotoxin with potential cardiovascular and cerebrovascular effects.
• The association between chronic alkaloidal cocaine use and moyamoya vasculopathy is not well-established, necessitating further investigation.

Observation:

• Two male patients with a history of prolonged alkaloidal cocaine use presented with distinct cerebrovascular events.
• One patient experienced an aneurysmal subarachnoid hemorrhage, a life-threatening condition caused by bleeding from a brain aneurysm.
• The second patient suffered an infarction in both cerebral lobes, indicating significant ischemic damage.

Findings:

• Both cases demonstrated moyamoya vasculopathy, a condition typically associated with genetic factors or other underlying diseases.
• Striking collateral development, specifically involving lenticulostriate networks, was observed in both patients, suggesting the brain's attempt to compensate for blocked arteries.
• The findings suggest a potential link between chronic alkaloidal cocaine abuse and the development of moyamoya vasculopathy and its associated complications.

Implications:

• This report highlights a potential iatrogenic cause of moyamoya vasculopathy, emphasizing the neurovascular risks associated with chronic alkaloidal cocaine consumption.
• Clinicians should consider moyamoya vasculopathy in patients with a history of substance abuse presenting with stroke or hemorrhage.
• Further research is warranted to elucidate the mechanisms by which alkaloidal cocaine may induce or exacerbate moyamoya vasculopathy.