Health Encyclopedia

Stroke related to cocaine use

Definition

Stroke related to cocaine use is a blockage in the blood supply to the brain and loss of brain function in someone who has used the drug, cocaine.

Causes, incidence, and risk factors

Cocaine is a product of the coca plant and an illegal recreational drug. It is a strong stimulant that increases activity of the central nervous system and the nerves that run away from the spinal cord (peripheral nervous system).

Cocaine use can cause a number of medical problems. Stroke related to cocaine probably occurs because cocaine causes blood vessels to narrow (constrict) while it increases blood pressure (hypertension). This vasoconstriction can be severe enough to reduce or block blood flow through the arteries in the brain. Cocaine use also can lead to swelling (inflammation) of the arteries of the brain.

Stroke related to cocaine is most common in men under 40 years old. A history of recent cocaine use is a risk.

A few people who experience stroke after using cocaine have an arteriovenous malformation, which may make them more likely to have a stroke. In these cases the stroke is due to bleeding in the brain instead of decreased blood flow.

Symptoms

Symptoms of cocaine use may include:

Symptoms of a stroke include:

Drowsiness, lethargy, or loss of consciousness
Loss of balance or coordination
Loss of memory
Mood changes
Numbness, tingling, decreased sensation
Personality changes
Slurred speach, inability to speak or understand speech, difficulty reading or writing
Swallowing difficulties or drooling
Uncontrollable eye movements or eyelid drooping
Vertigo
Vision changes
Weakness or paralysis of an arm, leg, side of the face, or any part of the body

Signs and tests

Your health care provider will take a medical history of your symptoms and history of cocaine use.

Signs include:

Abnormal eye movements
Changes in reflexes
Changes in vision or visual fields
Decreased sensation
Muscle weakness

You also may have signs of other disorders that occur with cocaine use.

Tests may include:

Motor tests
Nervous system (neurologic) tests
Sensory tests
Urine or blood toxicology screen

Treatment

Treatment may include not just the stroke, but also other disorders that may occur from cocaine use.

Possible treatments:

Amantadine to reduce the risk of taking drugs again
Dopamine agonist medications for cocaine withdrawal
Drugs to treat irregular heart rhythms (arrhythmias)
Sedatives such as diazepam and midazolam to reduce agitation and sleeping difficulties(insomnia)

A person who is in a coma may need life support, including tubes in the airway and a breathing machine (mechanical ventilation).

It is important to stop using cocaine. Treat cocaine addiction and any other addictions. Treatment should include monitoring for signs of cocaine withdrawal.

Because most people who are addicted to cocain are also addicted to other drugs (such as alcohol or heroin), withdrawal symptoms from these drugs should also be treated. Patients who are taking methadone for heroin addiction should continue to receive their regular dose.

Expectations (prognosis)

The outcome depends on:

Any other health conditions
The severity of the stroke
Withdrawal symptoms

The outcome is often poor, especially with long-term cocaine use. It is possible to die if many body systems stop functioning properly.

Complications

See stroke for a list of complications.

Calling your health care provider

Go to the emergency room or call 911 if you have any symptoms of stroke.

Prevention

Do not use cocaine to prevent having a stroke related to cocaine use.

References

Egred M, Davis GK. Cocaine and the heart. Postgrad Med J. 2005 Sep;81(959):568-71. Review.

Velasquez EM, Anand RC, Newman WP 3rd, Richard SS, Glancy DL. Cardiovascular complications associated with cocaine use. J La State Med Soc. 2004 Nov-Dec;156(6):302-10; quiz 311. Review.

Lucas CE. The impact of street drugs on trauma care. J Trauma. 2005 Sep;59(3 Suppl):S57-60; discussion S67-75.

Review Date:2/13/2008
Reviewed By:Luc Jasmin, MD, PhD, Departments of Anatomy & Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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