Cerebrovascular Effects Of Cocaine

Over five million Americans using cocaine regularly, and a survey in South London showed an increase in crack cocaine use from 16% to 59% amongst drug users. Common manifestations such as chest pain, hypertension, and psychiatric disturbances occur, but we must be alert for other serious unexpected presentations. Misdiagnoses are likely, especially as an accurate history may not be forthcoming, with cocaine toxicity masquerading as other common diseases. Subarachnoid haemorrhage, strokes of varying aetiologies, seizures, headache and sudden death are recognised associations of cocaine abuse. Seizures, for instance, have been reported to make up almost 10% of cocaine related admissions to emergency departments, and patients with prior seizure history, poor compliance with antiepileptic medication, alcohol abuse and poor diet or sleep habits are at greater risk. Simple management principles coupled to a high index of suspicion, are efficacious in the assessment and treatment of cocaine toxicity.