Cocaine use is an independent risk factor for cerebral vasospasm after aneurysmal subarachnoid hemorrhage

• Published in: Stroke (1970) 2001-10, Vol.32 (10), p.2338-2343
• Main Authors: CONWAY, James E, TAMARGO, Rafael J
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cocaine-Related Disorders - epidemiology; Comorbidity; Drug addictions; Female; Glasgow Outcome Scale; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neurology; Odds Ratio; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Factors; Severity of Illness Index; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - therapy; Tomography, X-Ray Computed; Toxicology; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasospasm, Intracranial - diagnosis; Vasospasm, Intracranial - epidemiology
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/hs1001.097041

Although acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH), the prevalence of vasospasm and the clinical outcome of patients experiencing aSAH associated with cocaine exposure are unclear. We have analyzed this patient population in our institution to address these issues. Between 1992 and 1999, 440 patients presented to our institution with aSAH. This sample was retrospectively analyzed to determine which patients had used cocaine within 72 hours of aSAH as documented by urine toxicology studies or patient history. These patients were then compared with control aSAH patients without recent cocaine exposure through univariable and multivariable analyses. Twenty-seven aSAH patients (6.1% of total) had either urine toxicology positive for cocaine metabolites (20 patients, 74%) or a history of cocaine use within 72 hours of aSAH (7 patients, 26%). Cocaine users were more likely to experience cerebral vasospasm defined as a delayed clinical deficit (from 3 to 16 days after aSAH) unexplained by concurrent CT scan and either responsive to hypervolemic and/or hypertensive therapy or accompanied by angiographic confirmation of vessel narrowing than control subjects (63% versus 30%; odds ratio [OR], 3.90; 95% confidence interval [CI], 1.77 to 8.62; P=0.001). Patients using cocaine were younger than control subjects (mean age, 36 versus 52 years; P