Stroke is a loss of brain function due to an interruption of the brain's blood supply. It can be caused by using the illegal drug cocaine.

Cocaine is a product of the coca plant and is an illegal recreational drug. It is not a narcotic (a drug which causes drowsiness and sleep, typically heroin or other opiates) although it is sometimes referred to as one.

Cocaine is a strong stimulant, which produces increased activity of the central nervous system  and the peripheral nervous system (the nerves that run away from the spinal cord).

Cocaine can be taken into the body in several ways and in several forms. Powdered cocaine (hydrochloride) can be snorted, injected, eaten, or applied to mucus membranes such as the vagina or rectum. The "freebase" form (often called crack) can be smoked.

The amount of cocaine required to produce an effect varies with the individual, the purity of the drug, and the means of taking it into the body. A smaller amount is used with injection into a vein or with smoking.

Cocaine use can cause a number of medical problems, including transient ischemic attacks (TIA), strokes, cardiovascular (heart and blood vessels) collapse, irregular heartbeats, and heart attacks. Stroke secondary to cocaine probably occurs because cocaine causes blood vessels to narrow (constrict) while also increasing blood pressure (hypertension). This vasoconstriction can be severe enough to reduce or block blood flow through the arteries in the brain.

Stroke secondary to cocaine is most common in men under 40 years old. Risks include a history of recent cocaine use. In a few people who experience stroke after using cocaine, an underlying arteriovenous malformation is found, which may have predisposed them to developing a stroke. In these cases the stroke is due to bleeding in the brain as opposed to decreased blood flow.

Cocaine use can also lead to lung damage from smoking, damage to veins, transmission of blood-borne diseases (due to dirty needles), damage to a unborn baby, and very high body temperatures(hyperthermia). Cocaine also causes mood swings, delirium, migraine-type headaches, and seizures.

Although it does not produce the dramatic withdrawal symptoms seen in heroin addiction, cocaine is extremely addictive and users who stop may experience severe drug craving, depression, and lethargy.

See Stroke.

Symptoms indicating cocaine use may include nosebleeds, headache, fatigue, inability to sleep, anxiety, depression, chronic hoarseness, and restlessness.

A medical history of symptoms and history of cocaine use, if known, are important in the diagnosis by the health care provider.

An examination may include neurologic, motor, and sensory testing. Examination may show changes in vision or visual fields, changes in reflexes including abnormal reflexes or abnormal extent of "normal" reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.

Signs of other disorders associated with the use of cocaine may be present.

Urine or blood toxicology screen may be positive, confirming cocaine use.

Treatment of stroke secondary to cocaine may be complicated by the need to treat the stroke, other disorders that may occur from the use of cocaine, and the need to treat any symptoms of withdrawal from cocaine such as drug craving, lethargy, and depression.

The person may be in a coma. There may be a need for life support, including placement of tubes into the airway and artificial ventilation (breathing assistance, breathing machines).

All use of cocaine must be stopped. Since most cocaine addicts are also addicted to other drugs (such as alcohol or heroin), symptoms of withdrawal from these drugs should also be looked for and treated as appropriate. Patients on methadone maintenance for heroin addiction should continue to receive their regular dose.

Heart arrhythmias (irregular beats) are treated with antiarrhythmic drugs or other medications.

Other conditions should be treated as appropriate.

The person should be continually observed for signs of cocaine withdrawal. Dopamine agonist medications may reduce symptoms of withdrawal from cocaine. Amantadine has been found to help reduce the risk of relapse in the most severely addicted patients. Sedatives, such as diazepam and midazolam, may be of some benefit in reducing agitation and insomnia. Plans for treatment of cocaine addiction and other addictions if present should be made if appropriate.

The outcome depends on the severity of the stroke, any other conditions that may be present, and withdrawal symptoms. The outcome is often poor, especially if the cocaine has been excessively used for a long time. Death caused by collapse of multiple body systems can occur.

See Stroke.

Go to the emergency room or call 911 if you have any symptoms of stroke.

Do not use cocaine.

Egred M, Davis GK. Cocaine and the heart. Postgrad Med J. 2005 Sep;81(959):568-71. Review.

Velasquez EM, Anand RC, Newman WP 3rd, Richard SS, Glancy DL. Cardiovascular complications associated with cocaine use. J La State Med Soc. 2004 Nov-Dec;156(6):302-10; quiz 311. Review.

Lucas CE. The impact of street drugs on trauma care. J Trauma. 2005 Sep;59(3 Suppl):S57-60; discussion S67-75.