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

Published:September 03, 2016DOI:
      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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        • Siniscalchi A
        • Sztajzel R
        • Bonci A
        • Malferrari G
        • Gallelli L
        Editorial: Cocaine and Cerebral Small Vessel: Is it Negative Factor for Intravenous Thrombolysis?.
        Curr Vasc Pharmacol. 2016; 14: 304-306
        • Cheng YC
        • Ryan KA
        • Qadwai SA
        • Shah J
        • Sparks MJ
        • Wozniak MA
        • et al.
        Cocaine Use and Risk of Ischemic Stroke in Young Adults.
        Stroke. 2016; 47: 918-922
        • Siniscalchi A
        • Bonci A
        • Mercuri NB
        • De Siena A
        • De Sarro G
        • Malferrari G
        • et al.
        Cocaine dependence and stroke: pathogenesis and management.
        Curr Neurovasc Res. 2015; 12: 163-172
        • Howington JU
        • Kutz SC
        • Wilding GE
        • Awasthi D
        Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhage.
        J Neurosurg. 2003; 99: 271-275
        • Levine SR
        • Brust JC
        • Futrell N
        • Brass LM
        • Blake D
        • Fayad P
        • et al.
        A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride-a review.
        Neurology. 1991; 41: 1173-1177
        • Kim HC
        • Nam CM
        • Jee SH
        • Suh I
        Comparison of Blood Pressure–Associated Risk of Intracerebral Hemorrhage and Subarachnoid Hemorrhage Korea Medical Insurance Corporation Study.
        Hypertension. 2005; 46: 393-397
        • Qureshi AI
        • Mendelow AD
        • Hanley DF
        Intracerebral haemorrhage.
        Lancet. 2009; 373: 1632-1644
        • Bajwa AA
        • Silliman S
        • Cury JD
        • Seeram V
        • Shujaat A
        • Usman F
        • et al.
        Characteristics and outcomes of cocaine-related spontaneous intracerebral hemorrhages.
        ISRN Neurol. 2013; 2013: 124390
        • Martin-Schild S
        • Albright KC
        • Misra V
        • Philip M
        • Barretto AD
        • Hallevi H
        • et al.
        Intravenous tissue plasminogen activator in patients with cocaine-associated acute ischemic stroke.
        Stroke. 2009; 40: 3635-3637
        • Siniscalchi A
        • Bonci A
        • Biagio Mercuri N
        • Pirritano D
        • Squillaci A
        • De Sarro G
        • et al.
        The Role of Topiramate in the Management of Cocaine Addiction: a Possible Therapeutic Option.
        Curr Neuropharmacol. 2015; 13: 815-818