Daras M, Tuchman A J, Marks S
Department of Neurology, New York Medical College, Metropolitan Hospital, New York 10029.
Stroke. 1991 Oct;22(10):1320-5. doi: 10.1161/01.str.22.10.1320.
Cocaine use in the United States has reached epidemic proportions, and increased availability of "crack" since 1983 has noticeably increased the incidence of neurovascular complications. In this report, we examine the relationship between cocaine use and ischemic infarct.
This study reports 18 cases of ischemic cerebrovascular events, which occurred among 15 men and three women aged 21-47 years who were evaluated in a 2-year period. Clinical presentations include thirteen cases with hemispheric infarcts, two brain stem strokes, two anterior spinal artery infarcts, and one with both hemispheric and cerebellar infarcts. Nine patients smoked crack, four snorted cocaine, and three injected it intravenously. In two cases, the route of administration could not be determined. Two patients died, but the other survived with various degrees of neurological deficit.
Traditional risk factors for strokes were identified in only six patients, suggesting that these factors are not necessary for the occurrence of a cocaine-related infarct. Multiple overlapping mechanisms may be responsible, including vasospasm, sudden onset of hypertension, myocardial infarction with cardiac arrhythmias, increased platelet aggregation, and vasculitis.
在美国，可卡因的使用已达到流行程度，自1983年以来“快克”可卡因的可获得性增加显著提高了神经血管并发症的发生率。在本报告中，我们研究了可卡因使用与缺血性梗死之间的关系。
本研究报告了18例缺血性脑血管事件，这些事件发生在15名男性和3名女性中，年龄在21至47岁之间，在两年期间接受了评估。临床表现包括13例半球梗死、2例脑干卒中、2例脊髓前动脉梗死以及1例同时有半球和小脑梗死。9例患者吸食快克可卡因，4例吸食可卡因，3例静脉注射可卡因。在2例中，给药途径无法确定。2例患者死亡，其他患者存活但有不同程度的神经功能缺损。
仅在6例患者中发现了传统的中风危险因素，这表明这些因素对于发生与可卡因相关的梗死并非必要条件。可能存在多种重叠机制，包括血管痉挛、高血压突然发作、伴有心律失常的心肌梗死、血小板聚集增加以及血管炎。
