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Cocaine use is linked to a rise in serious brain bleeds, including aneurysms and tumors. Cocaine-induced hypertension is a likely cause, highlighting the need for prompt diagnosis in affected patients.
Area of Science:
- Neurology
- Toxicology
- Cardiovascular Medicine
Background:
- Cocaine use has surged, leading to diverse medical conditions.
- Intracranial hemorrhage (ICH) is an increasingly recognized complication.
Observation:
- Presents 10 cases of ICH associated with cocaine use.
- Includes various ICH types: aneurysm rupture, arteriovenous malformation bleeding, tumor hemorrhage, and spontaneous ICH.
- Cases involved patients with and without pre-existing hypertension.
Findings:
- Cocaine-induced hypertension, via sympathetic stimulation, is a probable common factor.
- Arterial spasm caused by cocaine may also contribute to ICH.
- The pathophysiology linking cocaine to ICH is multifactorial.
Implications:
- Intracranial hemorrhage must be considered in patients with acute neurological changes and a history of cocaine use.
- Early recognition and intervention are crucial for managing cocaine-associated neurological emergencies.
- This association underscores the severe cerebrovascular risks of recreational cocaine consumption.
Abstract:
Cocaine use has increased rapidly over the past few years. This has led to an increase in the number and variety of cocaine-related conditions for which medical attention is sought. Among these have been several cases of intracranial hemorrhage. Four cases reported in the literature and 6 from our own institution are presented here. They represent different diagnoses including hemorrhage from aneurysms and arteriovenous malformations, hemorrhage into a tumor, and spontaneous hemorrhage with no underlying lesion with and without preexisting hypertension. Analysis of these cases suggests that the hypertension induced by cocaine secondary to sympathetic stimulation may be the common factor. Cocaine may also cause arterial spasm. Although the pathophysiology has not been entirely resolved, the clinical significance of this association is clear. Intracranial hemorrhage should be considered in the differential diagnosis whenever a patient presents with an acute alteration in neurologic examination associated with cocaine use.