Cocaine Use Increases Risk of Hemorrhagic Stroke

Cocaine users are found to be more likely to experience a hemorrhagic stroke (sudden bleeding in the brain), at a significantly earlier age and experience poorer outcome after treatment, than non-users. This group represents a portion of the 160,000 Americans who die from strokes each year.

"Hemorrhagic strokes are much more common in stroke patients with more recent cocaine ingestion," says Anil Nanda, MD, Chairman of the Department of Neurosurgery at Louisiana State University Health Sciences Center and co-author of a recent study on the topic. "Aneurysmal rupture is a direct consequence of the hemodynamic (relating to blood circulation) effects of cocaine."

The study was conducted over six years and focused on the treatment of 16 patients who had acute stroke and who were positively tested for cocaine. Their results were compared with 36 patients of similar ages who were treated during the same time frame for stroke, but who tested negative for cocaine.

Both hemorrhagic and non-hemorrhagic strokes were monitored in this study. Fifty percent of strokes in the cocaine-users group were hemorrhagic compared to 3 percent in the non-cocaine users group. In the United States, about 20 percent of strokes occur from hemorrhage, a sudden bleeding into or around the brain. Stroke occurs when blood flow to the brain is disrupted and brain cells lose their supply of nutrients. This happens when the brain receives too little, or too much, blood.

Victims of hemorrhagic stroke experience a rapid onset of symptoms that evolve over several hours, and include headache, nausea, vomiting and altered states. When the aneurysm ruptures, the victim may experience a terrible headache, neck stiffness, vomiting, confusion and altered states of consciousness.

To combat the aneurysms, all of the patients in the study, except one, received aggressive neurosurgical treatment involving removal of the aneurysms. In the study, 70 percent of patients improved after surgical intervention. An overall good result was achieved in 78 percent of the study group patients and 92 percent of the control group patients. The cases primarily involved patients under the influence of cocaine, who were complaining of severe headaches and neck stiffness.

"Though a direct association is not evident to us, the study does indicate that the combination of the significantly younger age of patients and smaller size of their aneurysms at rupture might suggest an association between cocaine use and the formation/rupture of aneurysms," says Dr. Nanda.

The study also showed that patients with cocaine-related aneurysms reportedly have a higher mortality rate than that of patients with no history of cocaine abuse. The cocaine group had a mortality rate of 50 percent compared to 2.7 percent in the non-cocaine group. Only 31 percent had a good outcome in cocaine users compared to 83 percent in the control group. It is evident that cocaine use appeared to have favored early rupture of these aneurysms at a smaller size and at a younger age, resulting in poorer post-surgery outcome.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.