Intracerebral hemorrhage (ICH) is a well-recognized complication of recreational 
cocaine use. The precise mechanism of the cocaine-induced hemorrhagic event is 
unclear, although multiple factors have been implicated. We report a case of a 
62-year-old woman who suffered left parieto-occipital ICH with herniation and 
death, following a cocaine binge. Microscopic examination also revealed 
extensive cerebral amyloid angiopathy (CAA) in the vicinity of the hemorrhage. 
We additionally studied brain tissue in eight subjects between ages of 60 and 80 
who were positive for cocaine metabolites at autopsy; of these, none had 
vascular amyloid-β deposits by immunohistochemistry. Whereas we found no 
evidence that chronic cocaine use is a risk factor for CAA, given the 
age-associated nature of CAA and the aging population using cocaine, CAA-induced 
hemorrhage in the setting of cocaine use may be more common than recognized. 
This is the first reported case of CAA-associated ICH precipitated by cocaine.