Cerebral infarction in a user of free-base cocaine ("crack")

After smoking "crack," the free-base form of cocaine, a 27-year-old man suffered an infarction of most of the territory of the right middle cerebral artery. Concomitant drug use seemed to have been limited to ethanol and ibuprofen. Search for other possible causes was negative. Angiography revealed narrowing of the supraclinoid portion of the right internal carotid artery (ICA) and cutoff of at least two distal branches. There was no beading or irregularity to suggest vasculitis. Crack may have induced vasospasm in the ICA through recognized sympathomimetic actions of cocaine.