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Intracerebral hemorrhage in a middle-aged cocaine user despite normal blood pressures

Published:September 03, 2016DOI:https://doi.org/10.1016/j.ajem.2016.09.003
      Increasing evidence supports the relationship between cocaine and hemorrhagic stroke in young patients, and the type of formulation plays an important role. High blood pressure has been reported to be a common important risk factor for intracerabral hemorrhage. We report the case of a 40-year-old woman who did not declare at admission her 4-year history of intranasal cocaine hydrochloride and developed an intracerebral subcortical spontaneous hemorrhage. She documented a normal blood pressure, and computer tomography angiography did not show vascular abnormalities and excluded the presence of arterial aneurisms. We performed a urine toxicology screen test revealing that she was positive for cocaine. Various mechanisms are involved in the etiologies of intracerebral hemorrhage in cocaine users. In the presence of normal blood pressure without vascular abnormalities, an endothelial dysfunction cannot be excluded.
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