Farooq Muhammad U, Bhatt Archit, Patel Mehul
Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
J Med Toxicol. 2009 Sep;5(3):134-8. doi: 10.1007/BF03161224.
Concurrent abuse of alcohol and cocaine results in the formation of cocaethylene, a powerful cocaine metabolite. Cocaethylene potentiates the direct cardiotoxic and indirect neurotoxic effects of cocaine or alcohol alone.
A 44-year-old female with history of cocaine and alcohol abuse presented with massive stroke in the emergency department. CT scan revealed extensive left internal carotid artery dissection extending into the left middle and anterior cerebral arteries resulting in a massive left hemispheric infarct, requiring urgent decompressive craniectomy. The patient had a stormy hospital course with multiple episodes of torsades de pointes in the first 4 days requiring aggressive management. She survived all events and was discharged to a nursing home with residual right hemiplegia and aphasia.
The combination of ethanol and cocaine has been associated with a significant increase in the incidence of neurological and cardiac emergencies including cerebral infarction, intracranial hemorrhage, myocardial infarction, cardiomyopathy, and cardiac arrhythmias. The alteration of cocaine pharmacokinetics and the formation of cocaethylene have been implicated, at least partially, in the increased toxicity of this drug combination.
酒精与可卡因同时滥用会导致一种强效可卡因代谢产物——可口乙酮的形成。可口乙酮会增强可卡因或酒精单独使用时的直接心脏毒性和间接神经毒性作用。
一名有可卡因和酒精滥用史的44岁女性在急诊科出现大面积中风。CT扫描显示广泛的左颈内动脉夹层延伸至左大脑中动脉和前动脉，导致大面积左半球梗死，需要紧急进行减压颅骨切除术。患者住院过程波折，在最初4天内多次发生尖端扭转型室速，需要积极治疗。她挺过了所有病情，出院后入住疗养院，遗留右半身瘫痪和失语症。
乙醇与可卡因的联合使用与包括脑梗死、颅内出血、心肌梗死、心肌病和心律失常在内的神经和心脏急症发生率显著增加有关。可卡因药代动力学的改变以及可口乙酮的形成至少部分地导致了这种药物组合毒性的增加。
