Intracranial hemorrhage and cocaine use (1987)

FRANÇAIS :
D'après six cas cliniques, les auteurs concluent à un risque d' hémorragie intracranienne chez des patients présentant de brusques altérations des fonctions neurologiques après consommation de cocaïne. L'hypertension produite par la drogue semble être le facteur commun de la majorité des patients ayant déjà des lésions vasculaires antérieures. L'usage de la cocaïne et du crack étant de plus en plus répandu et les complications telles que l'infarctus, l'avortement, les perturbations du comportement de nouveaux-nés de mères intoxiquées, les accidents cérébro-vasculaires, de plus en plus répandues, doivent attirer l' attention des chercheurs qui doivent en particulier étudier les cas de mort subite après absorption de cocaïne ; leur cause est indéterminée dans 25% des cas.
ENGLISH:
Cocaine use has increased rapidly over the past few years. This has led to an increase in the number and variety of cocaine-related conditions for which medical attention is sought. Among these have been several cases of intracranial hemorrhage. Four cases reported in the literature and 6 from our own institution are presented here. They represent different diagnoses including hemorrhage from aneurysms and arteriovenous malformations, hemorrhage into a tumor, and spontaneous hemorrhage with no underlying lesion with and without preexisting hypertension. Analysis of these cases suggests that the hypertension induced by cocaine secondary to sympathetic stimulation may be the common factor. Cocaine may also cause arterial spasm. Although the pathophysiology has not been entirely resolved, the clinical significance of this association is clear. Intracranial hemorrhage should be considered in the differential diagnosis whenever a patient presents with an acute alteration in neurologic examination associated with cocaine use.