Stroke secondary to cocaine

Definition
Stroke secondary to cocaine is a brain disorder caused by use of cocaine. It involves loss of brain function due interruption of the brain’s blood supply.

Causes, incidence, and risk factors

Cocaine is a product of the coca plant and is an illegal recreational drug. It is not a narcotic (a drug which causes drowsiness and sleep, typically heroin or other opiates) although it is referred to as one by the legal system.

Cocaine is a strong stimulant, which produces increased activity of the central nervous system (associated with the brain and spinal cord) and the peripheral nervous system (the nerves that stem from the spinal cord).

Cocaine can be taken into the body in several ways and in several forms. Powdered cocaine (hydrochloride) can be snorted, injected, eaten, or applied to other mucus membranes such as the vagina or rectum. The “freebase” form (often called crack) can be smoked.

The amount of cocaine required to produce an effect varies with the individual, with the purity of the drug, and with the means of taking it into the body. A smaller amount is usually required with injection into a vein or with Smoking.

Cocaine use can cause a number of medical problems - including cardiovascular (heart and blood vessels) collapse, irregular heartbeats, Heart attack , lung damage from Smoking, damage to veins, and transmission of blood-borne diseases due to injecting the drug using dirty needles, damage to a fetus, and very high temperature elevations (hyperthermia). Cocaine also causes mood swings, delirium, migraine-type headaches, seizures, transient ischemic attacks (TIA), and Strokes.

Although it does not produce the dramatic withdrawal symptoms seen in heroin addiction, cocaine is extremely addictive and users who stop may experience severe drug craving, Depression, and Lethargy.

Stroke secondary to cocaine probably occurs because cocaine causes blood vessels to narrow (constrict) while also increasing blood pressure (hypertension). This vasoconstriction can be severe enough to reduce or block blood flow through the arteries in the brain.

Stroke secondary to cocaine is most common in men under 40 years old. Risks include a history of recent cocaine use. In a few people who experience stroke after using cocaine, an underlying Arteriovenous malformation is found, which may have predisposed them to developing a stroke. In these cases the stroke is due to bleeding in the brain as opposed to decreased blood flow.

Symptoms
See Stroke.

Signs and tests

A medical history of symptoms and history of cocaine use, if known, are important in the diagnosis by the health care provider. Symptoms indicating cocaine use may include nosebleeds, headache, fatigue, inability to sleep, anxiety, Depression, chronic hoarseness, and restlessness. Maximum neurologic deficits commonly are present at the beginning (onset) of stroke caused by cocaine.

An examination may include neurologic, motor, and sensory testing to determine the specific neurologic deficits present, because they often correspond closely to the location of the injury to the brain. Examination may show changes in vision or visual fields, changes in reflexes including abnormal reflexes or abnormal extent of “normal” reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.

Signs of other disorders associated with the use of cocaine may be present (cardiovascular collapse, irregular heartbeats, Heart attack , lung damage, and others).

Urine or blood toxicology screen may be positive, confirming cocaine use.

Treatment
Treatment of stroke secondary to cocaine may be complicated by the need to treat the stroke, other disorders that may occur from the use of cocaine, and the need to treat any symptoms of withdrawal from cocaine such as drug craving, Lethargy, and Depression.

The person may be in a coma. There may be a need for life support, including placement of tubes into the airway and artificial ventilation (breathing assistance, breathing machines).

All use of cocaine must be stopped. Since most cocaine addicts are also addicted to other drugs (such as alcohol or heroin), symptoms of withdrawal from these drugs should also be looked for and treated as appropriate. Patients on methadone maintenance for heroin addiction should continue to receive their regular dose.

Heart arrhythmias (irregular beats) are treated with antiarrhythmic drugs or other medications.

Other conditions should be treated as appropriate.

The person should be continually observed for signs of cocaine withdrawal. Dopamine agonist medications may reduce symptoms of withdrawal from cocaine. Amantadine has been found to help reduce the risk of relapse in the most severely addicted patients. Sedatives, such as diazepam and midazolam, may be of some benefit in reducing agitation and Insomnia. Plans for treatment of cocaine addiction and other addictions if present should be made if appropriate.

Expectations (prognosis)
The outcome varies, depending on the severity of the stroke, any other conditions that may be present because of the use of cocaine, presence of withdrawal symptoms, and other factors. It is often poor, especially if the intoxication has been prolonged and excessive, with death caused by collapse of multiple body systems.

Complications
See Stroke.

Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if symptoms of stroke secondary to cocaine occur.

Prevention
Avoid illicit use of cocaine.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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