Document Detail

Cocaine-associated cerebral vasculitis.
MedLine Citation:
PMID:  8650587     Owner:  NLM     Status:  MEDLINE    
Cocaine use is associated with a variety of serious neurological complications, including cerebral infarction, intracerebral and subarachnoid hemorrhage, transient ischemic attacks, migraines, and seizures. We report two cases of intracerebral hemorrhage with biopsy-proven cerebral vasculitis associated with the use of cocaine. The first case involved a 32-year-old man who presented with headache, left-sided hemiparesis, and severe hypertension and who was found to have a large right putaminal hemorrhage on cranial tomographic (CT) scan. Cerebral angiography did not show vasculitic changes, but brain tissue obtained during hematoma evacuation revealed a nonnecrotizing leukocytoclastic angiitis of the small vessels. The second case involved a 20-year-old man who presented with headache, agitation, and speech difficulty that progressed to disorientation and dysphasia. He had a large left temporoparietal hematoma seen on CT scan. Cerebral angiography was consistent with vasculitis, and brain tissue obtained during hematoma evacuation revealed a small vessel vasculitis. In both cases, thorough clinical and laboratory investigations found no evidence of systemic vasculitis or an etiologic agent other than cocaine. We also critically reviewed the previously reported cases of cocaine-associated cerebral vasculitis and the relevant medical literature to discuss the "cocaine-associated vasculitis syndrome" in the context of more established vasculitidies, including hypersensitivity vasculitis. In addition, we outline a diagnostic and therapeutic approach to patients with possible cocaine-associated vasculitis.
P A Merkel; W J Koroshetz; M C Irizarry; M E Cudkowicz
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Seminars in arthritis and rheumatism     Volume:  25     ISSN:  0049-0172     ISO Abbreviation:  Semin. Arthritis Rheum.     Publication Date:  1995 Dec 
Date Detail:
Created Date:  1996-07-25     Completed Date:  1996-07-25     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  1306053     Medline TA:  Semin Arthritis Rheum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  172-83     Citation Subset:  IM    
Department of Medicine, Massachusetts General Hospital, Boston, 02114, USA.
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MeSH Terms
Cerebral Arteries / drug effects,  pathology
Cocaine / adverse effects*
Tomography, X-Ray Computed
Vasculitis / chemically induced*,  radiography
Grant Support
Reg. No./Substance:

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