Cocaine-Induced Massive Ischemic Stroke Treated by Decompressive Craniectomy with Favorable Outcome

Cocaine abuse is a significant health hazard with multiple cardiac and neurological complications. Cocaine-induced ischemic stroke can have multiple underlying pathophysiological mechanisms, resulting in various complex neurological presentations. We describe a case of a young man who had a massive ischemic multi-territorial stroke who was managed successfully with decompressive craniectomy with a favorable outcome. Cocaine use should be routinely suspected in young patients presenting with ischemic stroke, and a urine toxicology screen should be part of the initial workup for such patients. Brain magnetic resonance imaging is an essential neuroimaging modality, which is very helpful in confirming the ischemic insult and planning management. Early diagnosis and treatment are crucial due to potential reversibility and reduction of the size of infarcted tissue. In addition, multidisciplinary care, including a vascular neurosurgeon, should be implicated.