Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

A case of cocaine-induced basilar artery thrombosis

Nature Clinical Practice Neurology volume 4, pages 622–626 (2008)Cite this article

Abstract

Background A 40-year-old man presented to an emergency department with slurred speech, diplopia and agitation several hours after cocaine use. His level of consciousness rapidly dropped in the hours following presentation.

Investigations Physical examination, CT scan of the head, cerebral angiography.

Diagnosis Cocaine-induced basilar artery thrombosis.

Management Intra-arterial thombolysis, mechanical clot aspiration, intravenous abciximab, neurointensive care support, rehabilitation at a specialist stroke unit.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Brain CT scan in a patient with cocaine-induced basilar artery thrombosis.
Figure 2: Angiography in a patient with cocaine-induced basilar artery thrombosis.

References

  1. Nicholas S . et al (Eds; online July 2007) Home Office Statistical Bulletin: Crime in England and Wales 2006/07, edn 4 [http://www.homeoffice.gov.uk/rds/pdfs07/hosb1107.pdf] (accessed 27 June 2008)

  2. Daras M et al. (1994) Neurovascular complications of cocaine. Acta Neurol Scand 90: 124–129

    Article  CAS  Google Scholar 

  3. Levine SR et al. (1990) Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine. N Engl J Med 323: 699–704

    Article  CAS  Google Scholar 

  4. Treadwell SD et al. (2007) Cocaine use and stroke. Postgrad Med J 83: 389–393

    Article  CAS  Google Scholar 

  5. Krendel DA et al. (1990) Biopsy-proven cerebral vasculitis associated with cocaine abuse. Neurology 40: 1092–1094

    Article  CAS  Google Scholar 

  6. Fredericks RK et al. (1991) Cerebral vasculitis associated with cocaine use. Stroke 22: 1437–1439

    Article  CAS  Google Scholar 

  7. Sauer CM (1991) Recurrent embolic stroke and cocaine-related cardiomyopathy. Stroke 22: 1203–1205

    Article  CAS  Google Scholar 

  8. Vallee JN et al. (2003) Basilar artery occlusion treated by thromboaspiration in a cocaine and ecstasy abuser. Neurology 61: 839–841

    Article  Google Scholar 

  9. Konzen P et al. (1995) Vasospasm and thrombus formation as possible mechanisms of stroke related to alkaloidal cocaine. Stroke 26: 1114–1118

    Article  CAS  Google Scholar 

  10. Brandt T (2002) Diagnosis and thrombolytic therapy of acute basilar artery occlusion: a review. Clin Exp Hypertens 24: 611–622

    Article  Google Scholar 

  11. Gregory WA (1999) Expanding the window for thrombolytic therapy in acute stroke. Stroke 30: 2230–2237

    Article  Google Scholar 

  12. Voetsch B et al. (2004) Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 61: 496–504

    Article  Google Scholar 

  13. Eckert B et al. (2003) Acute basilar artery occlusion treated with combined intravenous abciximab and intra-arterial tissue plasminogen activator. Stroke 33: 1424–1427

    Article  Google Scholar 

  14. Bush SH (1998) Cocaine-associated myocardial infarction—a word of caution about thrombolytic therapy. Chest 94: 878

    Article  Google Scholar 

  15. Hollander J et al. (1995) Cocaine-associated myocardial infarction: clinical safety of thrombolytic therapy: Cocaine Associated Myocardial Infarction (CAMI) Study Group. Chest 107: 1237–1241

    Article  CAS  Google Scholar 

  16. Green RM et al. (1990) Multiple intracerebral haemorrhages after smoking crack cocaine. Stroke 21: 657–672

    Article  Google Scholar 

  17. Kibayashi K et al. (1995) Cocaine-induced intracerebral haemorrhage: analysis of predisposing factors and mechanisms causing haemorrhagic strokes. Hum Pathol 26: 659–663

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

  1. C MacEwen holds an ST3 post in Renal Medicine at the Churchill Hospital, Oxford, M Ward is a Consultant Physician in Acute General Medicine and Geratology, Oxford Radcliffe Hospitals NHS Trust, Oxford, and A Buchan is a Consultant Stroke Neurologist and holds a Chair in Clinical Geratology at the University of Oxford, Oxford, UK.,

    Clare MacEwen, Mike Ward & Alastair Buchan

Authors
  1. Clare MacEwen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mike Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alastair Buchan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clare MacEwen.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

MacEwen, C., Ward, M. & Buchan, A. A case of cocaine-induced basilar artery thrombosis. Nat Rev Neurol 4, 622–626 (2008). https://doi.org/10.1038/ncpneuro0879

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0879

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing