Severe non-occlusive ischemic stroke in young heroin addicts

Two heroin addicts, aged 30 and 35 years, developed severe ischemic stroke shortly after intravenous injection of heroin. Arteriograms, CT-scans, and Technesium-99 scintigrams demonstrated non-occlusive extensive infarctions in the carotid territory. Cerebral blood flow investigation in one showed severe hyperemia of the entire left carotid artery territory, including areas, where infarction did not develop. Stroke was not due to arterial occlusion. It was more likely due to generalized hypoxia combined with decreased perfusion pressure in the carotid territory on one site because of external compression of the carotid artery during the intoxicated comatose state.