Trejos Marisol, Nittala Solomon, Nedd Kester
Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Cureus. 2025 Mar 24;17(3):e81099. doi: 10.7759/cureus.81099. eCollection 2025 Mar.
Cocaine is an alkaloid-based extract made into cocaine hydrochloride, a substance found to influence the central nervous system to a higher degree when smoked and linked to numerous neurological ailments such as stroke, hemorrhage, seizures, and other cognitive impairments. We present the unique case of a 60-year-old male with unknown past medical history presenting initially with an acute ST-elevation myocardial infarction (STEMI) and a concurrent cardiocerebral infarction (more specifically in the bilateral globus pallidus stroke), with toxicology positive for cocaine intoxication. Lesions in the bilateral basal ganglia are usually correlated to carbon monoxide poisoning, cardiorespiratory arrest, hypovolemia, trauma, heroin usage, and methanol intoxication. However, in extremely rare instances, cocaine usage can lead to cerebral vasospasm causing infarction. Vascular thrombosis can be caused by platelet aggregation potentiated by cocaine. This unique presentation of bilateral basal ganglia with the comorbidity of a STEMI in association with cocaine intoxication encourages further research toward the usage of innovative imaging techniques such as positron emission tomography and single-photon emission computed tomography to facilitate viewing lesions associated with cerebral blood volume flow in cases where substance intoxication play a preeminent factor.
可卡因是一种基于生物碱的提取物，制成盐酸可卡因，这种物质在吸食时被发现对中枢神经系统有更高程度的影响，并与许多神经系统疾病有关，如中风、出血、癫痫发作和其他认知障碍。我们报告了一例独特病例，一名60岁男性，既往病史不明，最初表现为急性ST段抬高型心肌梗死（STEMI）和并发心脑梗死（更具体地说是双侧苍白球中风），毒理学检查显示可卡因中毒呈阳性。双侧基底节病变通常与一氧化碳中毒、心肺骤停、血容量不足、创伤、海洛因使用和甲醇中毒有关。然而，在极其罕见的情况下，使用可卡因可导致脑血管痉挛，进而引起梗死。可卡因可增强血小板聚集，从而导致血管血栓形成。这种双侧基底节独特表现合并STEMI以及可卡因中毒的情况，鼓励进一步研究使用创新成像技术，如正电子发射断层扫描和单光子发射计算机断层扫描，以便在物质中毒起主要作用的病例中，更便于观察与脑血容量流动相关的病变。
