Brain Disorders & Therapy

Cerebrovascular complications related to cocaine use

Global Summit on Stroke

August 03-05, 2015 Birmingham, UK

Antonio Siniscalchi1, Giovambattista De Sarro2, Antonello Bonci3, Giovanni Malferrari4 and Luca Gallelli2

Posters-Accepted Abstracts: Brain Disord Ther

Abstract:

Stroke represents the largest cause of severe disability and the third most common cause of death in developed countries.
Recently, strokes have become more prevalent in younger people. About 5% of strokes occur in people between 18 and
44 years. They appear to occur more in men more than women and blacks also have been reported to have a high incidence
of strokes in this age range. In young people, both hemorrhagic and ischemic stroke can result as a consequence of cocaine
exposure. In particular, crack cocaine seems to be associated with both ischemic strokes and hemorrhage strokes whereas
cocaine hydrochloride causes mainly intracerebral and subarachnoidal bleeding. Several mechanisms may be responsible
for the cerebrovascular complications. A sudden rise in systemic arterial pressure may cause haemorrhages frequently in
association with an underlying aneurysm. Vasospasm, vasculitis, myocardial infarction with cardiac arrhythmias and
increased platelet aggregation also may provoke ischemic stroke. Moreover, amphetamines co-use as well as the presence of
other adulterant ingredients (such as procainamide, quinidine and anti-histamines) in cocaine preparations may represent an
additional risk factors during cocaine hydrochloride users. In acute ischemic stroke caution should be exercised before using
intravenous and endovascular thrombolysis in these patients due to the higher risk of intracranial bleeding. In conclusion, it
is reasonable to screen young patients (including toxicology tests of blood or urine or the use of standardized questionnaires
to screen for drug use or misuse) particularly men for drug use when they present with cryptogenic stroke. In addition, every
effort should be made to encourage cessation of cocaine use particularly in the presence of other specific factors that increase
the risk of stroke.