intracranial hypertension 22 Bias 107 Binswanger's disease 82.87 Blepharospasm 308 -. anatomical basis 308 Blood flow velocity 359 -pressure 359 Brainstem 256.320 -infarction 3

Cerebral infarctions Or subarachnoid hemorrhages have been described in association with cocaine use. We describe a patient who initially developed a subarachnoid hemorrhage following cocaine use, due to the rupture of a saccular aneurysm. A year later, while in labor, she used cocaine again and developed a left middle cerebral artery infarct. Recurrent strokes, particularly those of a different nature such as a subarachnoid hemorrhage and an ischemic cerebral infarction a year apart from one another, have not to our knowledge been previously reported in association with the repeated use of cocaine.

Background: 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.Summary of Comment: 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 others survived with various degrees of neurological deficit.Conclusions: 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.