INTRODUCTION AND OBJECTIVE: The use of cocaine has been increasingly associated 
with cerebrovascular disease specially in young adults. We review the cases of 
stroke related to cocaine abuse in this group.
PATIENTS AND METHODS: We performed a retrospective study between 1989-1998. Data 
were obtained from the Young Adults Stroke Registry. To investigate the etiology 
of stroke all patients underwent cardiologic examination, coagulation and 
neuroimaging tests.
RESULTS: We identified 13 patients under 45 years of age with stroke related to 
cocaine abuse (0.39% of all strokes and 7.60% of the ones in young adults). Mean 
age in this group was 28.30 years. Eight developed ischemic manifestations (5 
infarcts, 2 TIAs and 1 encephalopathy with multiple ischemic lesions), 4 had 
intraparenchymal hemorrhages and 1 had a subarachnoid hemorrhage. The principal 
route of administration was intranasal and the time course from cocaine use to 
stroke ranged from several hours to several years. 61.53% had history of other 
drug abuse and in 84.61% other risk factors were identified. Angiographic 
studies demonstrated: arterial occlusions (3 cases), changes consistent with 
vasospasm (1), segmental narrowing (1) and arterial wall irregularities (1). No 
aneurysms or arterio-venous malformations were found. The frequency of 
cocaine-related stroke in young adults has decreased from 8.33% in 1989 to 5% in 
1998.
CONCLUSIONS: Cocaine is a well known cause of stroke, specially in young adults. 
In most cases other risk factors can be identified. Multiple overlapping 
mechanisms may be involved (vasospasm-thrombosis, high blood pressure, embolism.