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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. The use of cocaine and its adverse effects on the
nervous system will be featured at this year�s 68th Annual Scientific Meeting
of the American Association of Neurological Surgeons (AANS), April 8-13, in San
Francisco, California.
"Hemorrhagic strokes are much more common in stroke patients with more recent
cocaine ingestion," says Anil Nanda, MD, an AANS member from Louisiana,
Chairman of the Department of Neurosurgery at Louisiana State University Health
Sciences Center and co-author of a recent study on the topic. "Aneurismal
rupture is a direct consequence of the homodynamic (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.
Founded in 1931 as the Harvey Cushing Society, the American Association of
Neurological Surgeons is a scientific and educational association with nearly
5,500 members worldwide. The AANS is dedicated to advancing the specialty of
neurological surgery in order to provide the highest quality of neurosurgical
care to the public. All active members of the AANS must be Board-certified by
the American Board of Neurological Surgery. Neurosurgery is the medical
specialty concerned with the prevention, diagnosis, treatment and
rehabilitation of disorders that affect the spine, brain, nervous system and
peripheral nerves.
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