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This study reports 18 cases of ischemic cerebrovascular events,which occurred among 15 men and three women aged 21-47 years who were evaluated in a 2-year period.Clinical presentations include thirteen cases with hemispheric infarcts,two brain stem strokes,two anterior spinal artery infarcts,and one with both hemispheric and cerebellar infarcts.Nine patients smoked crack,four snorted cocaine,and three injected it intravenously.In two cases,the route of administration could not be determined.Two patients died,but the others survived with various degrees of neurological deficit.Traditional risk factors for strokes were identified in only six patients,suggesting that these factors are not necessary for the occurrence of a cocaine-related infarct.Multiple overlapping mechanisms may be responsible including vasospasm,sudden onset of hypertension,myocardial infarction with cardiac arrhythmias,increased platelet aggregation,and vasculitis. |
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