A 3-year prospective study of 31,081 admissions to an inner-city,
emergency trauma hospital revealed 33 patients less than or equal to 45
years of age who had a total of 35 acute neurovascular events (infarction
or hemorrhage) related to cocaine abuse (3% of the total 979
cocaine-related admissions). Fifty-four percent of the events were
ischemic, and 46% were hemorrhagic. Six patients died. The majority (63%)
of ischemic events were hemispheric and subcortical in distribution. Eleven
of 13 angiograms were abnormal (five aneurysms and two arteriovenous
malformations were identified). No case of "vasculitis" was seen. Seventy
percent of the patients exclusively abused crack cocaine, and 94% of the
neurovascular events were related to its use. No first-time cocaine users
were identified. During the last year of the study, 29% of the 558
cocaine-related admissions were psychiatric admissions, and most (58%) were
for treatment of depressive illness (34 patients were admitted for
attempted suicide).Abstract Teaser