BACKGROUND AND PURPOSE: Cocaine is a cause of intracerebral hemorrhage (ICH), 
but there are no large studies that have characterized the location, pathology, 
and outcome of patients with cocaine-associated ICH.
METHODS: We performed a retrospective analysis of all patients admitted to our 
stroke service from 2004 to 2007 who had nontraumatic ICH and urine drug screens 
positive for cocaine and compared them with similar patients who had negative 
drug screens for cocaine.
RESULTS: We identified 45 patients with cocaine-associated ICH and 105 patients 
with cocaine-negative ICH. There were no significant differences in age or 
gender, but there was a significantly higher incidence of black patients in the 
cocaine-positive group. Cocaine-associated ICH patients had higher admission 
blood pressures, significantly more subcortical hemorrhages, and higher rates of 
intraventricular hemorrhage compared to patients with cocaine-negative ICH. 
Cocaine-positive patients had worse functional outcome, defined as modified 
Rankin Scale score >3 at the time of discharge (OR, 4.90; 95% CI, 2.19-10.97), 
and were less likely to be discharged home or to inpatient rehabilitation. 
Patients with cocaine-associated ICH were nearly 3-times more likely to die 
during their acute hospitalization when compared to cocaine-negative patients.
CONCLUSION: Recent cocaine ingestion is associated with hemorrhages that occur 
more frequently in subcortical locations, have a higher risk of intraventricular 
hemorrhage, and have a poor prognosis compared to patients with 
cocaine-negative, spontaneous ICH.