Cerebrovascular Complications of the Use of the Crack Form of Alkaloidal Cocaine
New England Journal of MedicinePublished 13 September 1990Open access
Steven R. Levine, John C.M. Brust, Nancy Futrell, K. -L. Ho, David Blake, Clark H. Millikan
Citations385
SJR quartileQ1
SJR score19.08
SNIP13.47
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
There is a strong temporal association of the use of alkaloidal cocaine with both ischemic and hemorrhagic cerebrovascular events that should be part of the evaluation of any young patient with a stroke.
Abstract
There is a strong temporal association of the use of alkaloidal cocaine with both ischemic and hemorrhagic cerebrovascular events. Cocaine-related stroke probably has many causes. A thorough history focusing on the use of cocaine and toxicologic screening of urine and serum should be part of the evaluation of any young patient with a stroke.
Keywords
MedicineNeurosciencePharmacology, Toxicology and Pharmaceutics
New England Journal of MedicineMedical Complications of Cocaine Abuse
796 Citations1986Louis L. Cregler, Herbert Mark
The earliest known use of cocaine, as suggested by the finding of coca leaves in the tombs of Indian mummies, was in 600 A.D, but it was not until 1855 that cocaine was isolated from the leaves.
New England Journal of MedicineCocaine-Induced Coronary-Artery Vasoconstriction
625 Citations1989Richard A. Lange, Ricardo G. Cigarroa +7 more
New England Journal of MedicineNecrotizing Angiitis Associated with Drug Abuse
538 Citations1970Bernard Citron, Mordecai Halpern +6 more
NeurologyCorrelation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis
518 Citations1989Stephen M. Rao, Gary J. Leo +3 more
It is suggested that cerebral lesions in MS produce cognitive dysfunction and that MRI may be a useful predictor of cognitive dysfunction.
The Journal of PediatricsPerinatal cerebral infarction and maternal cocaine use
374 Citations1986Ira J. Chasnoff, Mary E. Bussey +2 more
Chez un enfant ne a terme d'une mere ayant absorbe par aspiration nasale de fortes doses de cocaine durant les 5 premieres semaines de sa grossesse puis durant le 3 jours precedant l'accouchement.
The British Journal of PsychiatryCerebral Blood Flow in Chronic Cocaine Users: A Study with Positron Emission Tomography
371 Citations1988Nora D. Volkow, Nizar A. Mullani +3 more
It is hypothesised that some of the widespread defects in CBF in the cocaine users could reflect the effects of vasospasm in cerebral arteries exposed chronically to the sympathomimetic actions of cocaine.
HaemostasisPlatelet Responsiveness and Biosynthesis of Thromboxane and Prostacyclin in Response to in vitro Cocaine Treatment
224 Citations2009G. Togna, E. Tempesta +4 more
Results lead us to believe that cocaine modifies both the Ca++ membrane binding and the extent of Ca++ influx, thereby increasing the permeability to arachidonic acid and altering the affinity of the membrane binding sites for the aggregating agents.
Journal of Clinical InvestigationTHE EFFECTS OF l-EPINEPHRINE AND l-NOR-EPINEPHRINE UPON CEREBRAL CIRCULATION AND METABOLISM IN MAN 1
218 Citations1952Benton D. King, Louis Sokoloff +1 more
A preliminary report by Sensenbach, Madison, and Ochs indicates that nor-epinephrine is a powerful cerebral vasoconstrictor, and information regarding their effect on cerebral blood flow and cerebral metabolism is desirable.
The American Journal of MedicineAcute neurologic and psychiatric complications associated with cocaine abuse
217 Citations1987D H Lowenstein, Stephen M. Massa +4 more
The most serious consequences were found in patients with prolonged seizures or strokes, those who jumped out of buildings, and those who attempted suicide by overdosing with other drugs.
Archives of NeurologySubarachnoid Hemorrhage Precipitated by Cocaine Snorting
182 Citations1984P. J. Lichtenfeld, D. B. Rubin +1 more
Two cases of subarachnoid hemorrhage that occurred within several minutes of "snorting" cocaine were studied, finding that the bleeding was from an anterior communicating artery aneurysm and an arteriovenous malformation in the temporoparietal region.
Clinical Pharmacology & TherapeuticsKinetics of cocaine distribution, elimination, and chronotropic effects
178 Citations1985May J. Chow, John Ambre +4 more
The kinetic analysis demonstrated that the chronotropic effects of cocaine decline more rapidly than either plasma levels or biophase concentrations, and could be modeled as a first‐order process and is compatible with either the intervention of homeostatic reflex mechanisms or the phenomenon of acute tolerance.
Archives of NeurologyStroke Associated With Cocaine Use
173 Citations1989David C. Klonoff, B. T. Andrews +1 more
The data indicate that the apparent incidence of stroke related to cocaine use is increasing, cocaine-associated stroke occurs primarily in young adults, and stroke may follow any route of cocaine administration.
NeurologyBiopsy‐proven cerebral vasculitis associated with cocaine abuse
173 Citations1990David A. Krendel, Susan M. Ditter +2 more
Journal of EthnopharmacologyCocaine pharmacokinetics in humans
165 Citations1981Gene Barnett, Richard L. Hawks +1 more
While routes of administration for modern recreational use could lead to unexpected drug accumulation in the blood it is not likely to occur from chewing coca leaves.
Journal of Forensic SciencesCocaine and Sudden “Natural” Death
158 Citations1987RE Mittleman, Charles V. Wetli
Data indicate that cocaine may precipitate the sudden death of an individual with undiagnosed cardiovascular disease, and a review of the current medical literature indicates that cocaine should be considered in any apparently natural death occurring in a population where cocaine abuse is prevalent.
Annals of Internal MedicineReversible Cardiomyopathy Associated with Cocaine Intoxication
152 Citations1989Saurabh K. Chokshi, Richard Moore +2 more
Excerpt Cocaine intoxication typically produces a profoundly enhanced sympathomimetic state and has been temporally associated with various serious, including fatal, medical disorders.
PubMedThe pathology and etiology of cocaine-induced heart disease.
152 Citations1988Steven B. Karch, Margaret E. Billingham
The currently known morphological changes induced by cocaine are reviewed and the possible mechanisms of action leading to these changes are discussed.
The American Journal of MedicineDilated cardiomyopathy and cocaine abuse. Report of two cases
152 Citations1986Roy S. Wiener, Jeffrey T. Lockhart +1 more
Long-term cocaine use may cause dilated cardiomyopathy and recurrent myocardial infarction, even in the absence of atherosclerotic epicardial coronary artery disease.
NeurologyNeurologic complications of cocaine abuse
149 Citations1988CYRUS K. MODY, Bruce L. Miller +3 more
The recent availability of crack has led to a great increase in neurologic problems associated with the use of this drug, with patients with neurologic disease associated with cocaine abuse developing previously unreported complications.
American Journal of Physiology-Legacy ContentInfluence of endogenous norepinephrine on cerebral blood flow and metabolism
147 Citations1976Eric T. MacKenzie, James McCulloch +1 more
These experiments suggest that central norepinephrine can influence the cerebral circulation primarily through noradrenergic effects on brain metabolism.
JAMACerebral vasculitis associated with cocaine abuse
147 Citations1987Brian R. Kaye
Cocaine with methamphetamines, heroin, and ephedrine are included in the list of illicit drugs that can cause cerebral vasculitis in men with a history of cocaine abuse.
The American Journal of MedicineProtracted elimination of cocaine metabolites in long-term, high-dose cocaine abusers
146 Citations1988Roger D. Weiss, Frank H. Gawin
Three cases of veryhigh-dose cocaine abuse are reported, in which benzoylecgonine continued to be detected for 10 to 22 days after cessation of cocaine intake, and some authors have suggested that cocaine disposition or metabolism may vary with the amount or frequency of drug intake.
RadiologyCerebral Vascular Changes Secondary to Amphetamine Abuse in the Experimental Animal
141 Citations1971Calvin L. Rumbaugh, R. Thomas Bergeron +5 more
All 5 animals at necropsy demonstrated extensive brain damage and there were focal areas of ischemia and infarction and generalized areas of cerebral edema and ischemic nerve cell changes.
New England Journal of MedicineCocaine and Vasospasm
133 Citations1989Jeffrey M. Isner, Saurabh K. Chokshi
The clinical reports published over the past decade have established the fact that recreational abuse of cocaine may result in acute myocardial infarction, and at least 58 cases of acuteMyocardial Infarction are reported.
RadiologyCocaine abuse: neurovascular complications.
125 Citations1989I G Jacobs, Myer H. Roszler +3 more
In a review of the records of 3,712 drug abusers, 13 patients were identified with neurologic deficits attributable to the use of cocaine, withIschemic manifestations were the most frequent, occurring in seven patients, with a mean age of 34.2 years.
Journal of Forensic SciencesAnalysis of Cocaine-Positive Fatalities
113 Citations1989Kenneth Tardiff, Erica R. Gross +3 more
A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies, and of particular interest were 6 persons who died of acute cardiac events directly related to cocaine.
Neurology“Crack” cocaine‐associated stroke
111 Citations1987Steven R. Levine, J. M. Washington +5 more
Although the exact mechanism of cocaine-related stroke remains uncertain, both disordered neurogenic control of the cerebral circulation as well as systemic factors (ie, acute hypertension) may play a role.
StrokeIntracranial hemorrhage and cocaine use.
106 Citations1987Joan C. Wojak, Eugene S. Flamm
Analysis of cases of intracranial hemorrhage suggests that the hypertension induced by cocaine secondary to sympathetic stimulation may be the common factor and should be considered in the differential diagnosis whenever a patient presents with an acute alteration in neurologic examination associated with cocaine use.
NeurologyCerebral infarction in a user of free‐base cocaine (“crack”)
103 Citations1986Lawrence I. Golbe, Michael D. Merkin
Angiography revealed narrowing of the supraclinoid portion of the right internal carotid artery (ICA) and cutoff of at least two distal branches and there was no beading or irregularity to suggest vasculitis.
Archives of NeurologySubarachnoid Hemorrhage Precipitated by Cocaine Snorting
93 Citations1984Kenneth A. Schwartz, Jerry A. Cohen
A 23-year-old woman was admitted to the hospital with a fivehour history of the sudden onset of intense head, neck, and eye pain after snorting cocaine, and was described as having no prior history of headaches.
Annals of Emergency MedicineClinical toxicity of cocaine adulterants
91 Citations1988Michael Shannon
The comprehensive toxic screen, which provides multiple modalities of drug analysis, will be a key diagnostic tool in the further investigation of these inherently toxic agents and their impact on syndromes of cocaine intoxication.
Life SciencesCardiovascular effects of cocaine in anesthetized and conscious rats
89 Citations1987David K. Pitts, Celestine Udom +1 more
The results suggest that: the depressor phase is likely due to a interaction between local anesthetic activity (cocaine and procaine) and barbiturate anesthesia, the cardiovascular effects of cocaine in conscious animals are more similar to those observed in urethane anesthetized rats than in pentobarbital anESThetized animals, and the pressor effect in UrethaneAnesthetization rats is apparently due toA reserpine resistant catecholaminergic mechanism.
StrokeMultiple intracerebral hemorrhages after smoking "crack" cocaine.
87 Citations1990R M Green, Kristen M. Kelly +3 more
The multifocality of the hematomas and lack of underlying disease suggest that the hemorrhages resulted from cocaine-induced acute hypertension or arterial spasm, possibly potentiated by heavy ethanol consumption.
Acta Neurologica ScandinavicaCocaine-related intracranial hemorrhage. Report of nine cases and review
80 Citations1988John Mangiardi, Michael Daras +3 more
The relationship between severe cocaine‐induced hypertension, and the development of subarachnoid or intracerebral hemorrhages is noted, and apparently is related to sudden transient increases of blood pressure related to cocaine use.
Journal of Forensic SciencesCocaine-Related Death
70 Citations1977George D. Lundberg, James C. Garriott +3 more
This report documents nine cases of death associated with cocaine use; in three of these cocaine appears to be causative, and cocaine should be considered in serious drug overdose-reactions, especially after illicit injection.
PubMedCocaine, pregnancy, and postpartum intracerebral hemorrhage.
65 Citations1989Alvaro Jara, Gerry Johnson +2 more
A case of cocaineassociated intracerebral hemorrhage in the postpartum period which complicated the differential diagnosis and management of hypertension and seizures is reported.
PubMedIntracerebral hemorrhage associated with cocaine abuse.
60 Citations1989Kathleen Nolte, Benjamin B. Gelman
It is suggested that the pharmacodynamic effects of cocaine on the cerebral vasculature is the most likely cause of sudden death in a young person due to intracerebral hemorrhage associated with cocaine abuse.
Journal of Computer Assisted TomographySubcortical Cerebral Hemorrhages Associated with Cocaine Abuse
51 Citations1989Gail Nails, Anthony Disher +3 more
Four young individuals with histories of heavy cocaine abuse occurring several hours to days before the development of acute symptoms of severe headaches, disorientation, and subsequent stupor were shown to harbor sub-cortical cerebral hemorrhages.
NatureSite of Action of Cocaine on the Perfused Artery
47 Citations1967I.S. de la Lande, J. G. Waterson
NeurologyThalamomesencephalic strokes after cocaine abuse
46 Citations1989Howard A. Rowley, Daniel H. Lowenstein +2 more
It is suggested that direct adrenergic-mediated vaso-constriction is not critical to the production of cocaine-associated stroke, and the P1 segment has a uniquely sparse perivascular sympathetic supply.
Pediatric NeurologyIntracranial hemorrhage in a neonate following prenatal cocaine exposure
39 Citations1989Mary Catherine Spires, Elizabeth F. Gordon +3 more
The findings indicate the importance of considering cerebrovascular events in neonates exposed to cocaine in utero and highlight the need to monitor for these events during pregnancy and in the weeks after birth.
Annals of Internal MedicineComplications of Cocaine Abuse
38 Citations1987JORDI ALTÉS-CAPELLÀ, JOSÉ M. CABEZUDO-ARTERO +1 more
The use of cocaine has reached epidemic proportions in several areas in America and in Europe, the number of users is steadily growing, as is the occurrence of organic damage as a result of the use.
Postgraduate Medicine‘Crack’
37 Citations1986Arnold M. Washton, Mark S. Gold +1 more
The healthcare community is warned to prepare for an unprecedented influx of patients as the problem becomes even more prevalent and a basic treatment plan for abusers of this exceptionally addictive drug is suggested.
PubMedCocaine-induced central retinal artery occlusion.
37 Citations1988P Devenyi, Jennifer Schneiderman +2 more
Occlusion of the central retinal artery associated with cocaine use is described -this complication has never previously been reported.
Annals of Emergency MedicineAcute cocaine abuse associated with cerebral infarction
35 Citations1990Matthew F Seaman
The case of a 29-year-old patient who developed a cerebral infarction, without hemorrhage, after using cocaine is presented and theories of cocaine-induced cerebralinfarction are reviewed.
PubMedNeurologic aspects of cocaine abuse.
35 Citations1988Rowbotham Mc
These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco.
Journal of Forensic SciencesCocaine-Related Deaths in Pima County, Arizona, 1982–1984
35 Citations1986James A. Rogers, Tiernan Henry +3 more
A three-year review of toxicology data from medical examiner autopsies in Pima County, Arizona, has demonstrated that cocaine has rapidly become a leading substance of abuse, second only to alcohol in the frequency of drugs detected by toxicologic analysis of all suspicious deaths, motor vehicle accident fatalities, homicides, and suicides.
PsycEXTRA DatasetArteriosclerotic Toxicity of Cocaine
26 Citations1988Ronald O. Langner, C L Bement +1 more
Data suggest that the abuse of cocaine may result in damage to the aorta, which could result in the premature onset of cardiovascular disease and its complications.
OtolaryngologyDysphagia and Dysarthria as a Result of Cocaine Abuse
13 Citations1988Richard A. DeVore, Harvey M. Tucker
A 22-year-old black woman had a bilateral pontine stroke soon after she had used cocaine, prompting an alert to the potential for possible cerebrovascular accident and other complications of cocaine, in both clinical and recreational use.