BACKGROUND: Cocaine use has been temporally associated with neurovascular 
complications, including the rupture of intracerebral aneurysms. The purpose of 
the current study was to determine the type of neurovascular complications 
associated with cocaine use in our patient population, the temporal relationship 
between cocaine use and their onset, and whether cocaine users with subarachnoid 
hemorrhage (SAH) presented with smaller aneurysms at an earlier age than a 
control group of noncocaine users with SAH.
METHODS: Thirty-three patients who presented to the Detroit Medical Center with 
neurovascular sequelae associated with cocaine use were identified. All patients 
were chronic cocaine users who related a history of recent use confirmed by a 
drug screen. Cocaine users with SAH were compared to a control group of 44 
patients with SAH who presented without evidence of cocaine use.
RESULTS: Sixteen patients presented with SAH. Twelve patients subsequently 
underwent four-vessel cerebral arteriogram revealing 14 aneurysms; six patients 
presented with intracerebral hemorrhage (ICH) and seven patients with evidence 
of ischemic stroke. Eighteen (54.5%) patients noted onset of their symptoms 
while using cocaine, 87.9% noted onset within 6 hours of use. Delayed 
presentation occurred predominantly in patients who suffered ischemic strokes. 
The average age of patients who used cocaine and presented with SAH secondary to 
a ruptured intracerebral aneurysm was 32.8 years with an average aneurysm 
diameter of 4.9 mm versus an average age of 52.2 years with an average aneurysm 
diameter of approximately 11.0 mm in noncocaine users. Population differences 
were statistically significant at the p < 0.05 level. Mortality was 27.3% for 
patients who presented with neurovascular sequelae of their cocaine use, with 
77.8% of deaths occurring in patients who presented with SAH.
CONCLUSIONS: Chronic cocaine use appears to predispose patients who harbor 
incidental neurovascular anomalies to present at an earlier point in their 
natural history than similar non-cocaine users.