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David C. Klonoff, MD; Brian T. Andrews, MD; William G. Obana, MD

Arch Neurol. 1989;46(9):989-993.

Abstract
• We describe eight patients in whom cocaine use was related to stroke and review 39 cases from the literature. Among these 47 patients the mean (± SD) age was 32.5 ± 12.1 years; 76% (34/45) were men. Stroke followed cocaine use by inhalation, intranasal, intravenous, and intramuscular routes. Intracranial aneurysms or arteriovenous malformations were present in 17 of 32 patients studied angiographically or at autopsy; cerebral vasculitis was present in two patients. Cerebral infarction occurred in 10 patients (22%), intracerebral hemorrhage in 22 (49%), and subarachnoid hemorrhage in 13 (29%). These data indicate that (1) the apparent incidence of stroke related to cocaine use is increasing; (2) cocaine-associated stroke occurs primarily in young adults; (3) stroke may follow any route of cocaine administration; (4) stroke after cocaine use is frequently associated with intracranial aneurysms and arteriovenous malformations; and (5) in cocaine-associated stroke, the frequency of intracranial hemorrhage exceeds that of cerebral infarction.

Author Affiliations
From the Department of Medicine, Peninsula Hospital, Burlingame, Calif (Dr Klonoff), and the Departments of Medicine (Dr Klonoff) and Neurological Surgery (Drs Andrews and Obana), University of California at San Francisco.

Footnotes
Accepted for publication February 15, 1989.

Presented as a poster exhibit at the 38th annual meeting of the Congress of Neurological Surgeons, Seattle, Wash, September 25-29, 1988.

Reprint requests to Metabolic Research Unit, Room 1141-HSW, University of California at San Francisco, San Francisco, CA 94143-0540 (Dr Klonoff).

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