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Drug abuse and intracranial hemorrhage

Mario Pozzi1, Daria Roccatagliata, Roberto Sterzi

  • 1SC Neurologia, A.O. Niguarda P.za Ospedale Maggiore 3, 20162, Milano, Italy.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|October 4, 2008
PubMed

Insights

The rate of strokes in amphetamine and cocaine users is rising due to unclear mechanisms. Cerebral angiography is recommended for cocaine-related brain hemorrhages, particularly those in the lobes or ventricles.

Area of Science:

  • Neurology
  • Toxicology
  • Cardiovascular Medicine

Background:

  • Increasing incidence of strokes in individuals abusing amphetamines and cocaine.
  • Unclear underlying pathophysiological mechanisms contributing to substance-induced strokes.
  • Potential contributing factors include vasospasm, vasculitis, platelet aggregation, cardioembolism, and hypertension.

Purpose of the Study:

  • To investigate the mechanisms behind the rising stroke rates in stimulant abusers.
  • To highlight the role of pre-existing vascular lesions in these patients.
  • To provide recommendations for diagnostic imaging in specific stroke presentations.

Main Methods:

  • Review of existing literature on stimulant abuse and cerebrovascular events.
  • Analysis of potential etiological factors implicated in stroke pathogenesis.
  • Evaluation of the prevalence of pre-existing vascular abnormalities.

Main Results:

  • Approximately 40% of patients with stimulant-related strokes have pre-existing vascular lesions such as aneurysms or arteriovenous malformations.
  • Multiple mechanisms including vasospasm, vasculitis, and hypertensive surges are suspected.
  • Cerebral angiography is a key diagnostic tool.

Conclusions:

  • The increasing rate of strokes in amphetamine and cocaine abusers necessitates further research into causative mechanisms.
  • Pre-existing vascular lesions are common in this patient population.
  • Cerebral angiographic examination is crucial for managing cocaine-related intracerebral hemorrhage, especially lobar or intraventricular types.

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