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Embolic stroke after smoking "crack" cocaine
G W Petty1, J C Brust, T K Tatemichi
1Department of Neurology, Harlem Hospital Center, New York.
Insights
Cocaine use can cause ischemic stroke through embolism. Cardiomyopathy, potentially from cocaine, may lead to cardiac thrombus and subsequent cerebral infarction.
Area of Science:
- Neurology
- Cardiology
- Toxicology
Background:
- Cocaine abuse is associated with various cardiovascular and cerebrovascular complications.
- Ischemic stroke is a known risk of stimulant drug use, but the specific mechanisms are not fully elucidated.
Observation:
- A 39-year-old woman presented with an embolic occlusion of a middle cerebral artery branch.
- This event occurred three hours after smoking crack cocaine.
- Cardiac evaluation revealed cardiomyopathy and a left atrial thrombus.
Findings:
- The case illustrates that embolism is a significant mechanism for cocaine-associated ischemic stroke.
- Cocaine-induced cardiomyopathy may serve as the source of the embolus.
- A left atrial thrombus was identified as the likely embolic source.
Implications:
- In patients with cocaine-associated cerebral infarction, a thorough cardiac evaluation is crucial.
- Identifying a cardiac source of embolism can guide treatment and prevention strategies.
- This highlights the complex interplay between recreational drug use and cardiovascular health impacting neurological outcomes.
Abstract:
A 39-year-old woman had an embolic upper division middle cerebral artery branch occlusion 3 hours after smoking the free base of cocaine ("crack"). Radionuclide ventriculography demonstrated cardiomyopathy, and echocardiography documented a left atrial thrombus. This case demonstrates that embolism is one mechanism of ischemic stroke after cocaine use, and that cardiomyopathy, possibly cocaine induced, may be the source of embolus. A cardiac source of embolus should be sought in patients with cocaine-associated cerebral infarction.