Cocaine is a product of the coca plant and an illegal recreational drug. It is a strong stimulant that increases activity of the central nervous system and the nerves that run away from the spinal cord (peripheral nervous system).

Cocaine use can cause a number of medical problems. Stroke related to cocaine probably occurs because cocaine causes blood vessels to narrow (constrict) while it increases blood pressure (hypertension ). This vasoconstriction can be severe enough to reduce or block blood flow through the arteries in the brain. Cocaine use also can lead to swelling (inflammation) of the arteries of the brain.

Stroke related to cocaine is most common in men under 40 years old. A history of recent cocaine use is a risk.

A few people who experience stroke after using cocaine have an arteriovenous malformation , which may make them more likely to have a stroke. In these cases the stroke is due to bleeding in the brain instead of decreased blood flow.

Symptoms of cocaine use may include:

• Anxiety
• Depression
• Fatigue
• Headache
• Hoarseness
• Inability to sleep
• Nosebleeds
• Restlessness

Symptoms of a stroke include:

• Drowsiness, lethargy , or loss of consciousness
• Loss of balance or coordination
• Loss of memory
• Mood changes
• Numbness, tingling, decreased sensation
• Personality changes
• Slurred speach, inability to speak or understand speech, difficulty reading or writing
• Swallowing difficulties or drooling
• Uncontrollable eye movements or eyelid drooping
• Vertigo
• Vision changes
• Weakness or paralysis of an arm, leg, side of the face, or any part of the body

Your health care provider will take a medical history of your symptoms and history of cocaine use.

Signs include:

• Abnormal eye movements
• Changes in reflexes
• Changes in vision or visual fields
• Decreased sensation
• Muscle weakness

You also may have signs of other disorders that occur with cocaine use.

Tests may include:

• Motor tests
• Nervous system (neurologic) tests
• Sensory tests
• Urine or blood toxicology screen

Treatment may include not just the stroke, but also other disorders that may occur from cocaine use.

Possible treatments:

• Amantadine to reduce the risk of taking drugs again
• Dopamine agonist medications for cocaine withdrawal
• Drugs to treat irregular heart rhythms (arrhythmias )
• Sedatives such as diazepam and midazolam to reduce agitation and sleeping difficulties(insomnia)

A person who is in a coma may need life support, including tubes in the airway and a breathing machine (mechanical ventilation).

It is important to stop using cocaine. Treat cocaine addiction and any other addictions. Treatment should include monitoring for signs of cocaine withdrawal.

Because most people who are addicted to cocain are also addicted to other drugs (such as alcohol or heroin), withdrawal symptoms from these drugs should also be treated. Patients who are taking methadone for heroin addiction should continue to receive their regular dose.

The outcome depends on:

• Any other health conditions
• The severity of the stroke
• Withdrawal symptoms

The outcome is often poor, especially with long-term cocaine use. It is possible to die if many body systems stop functioning properly.

See stroke for a list of complications.

Go to the emergency room or call 911 if you have any symptoms of stroke.

Do not use cocaine to prevent having a stroke related to cocaine use.

Egred M, Davis GK. Cocaine and the heart. Postgrad Med J. 2005 Sep;81(959):568-71. Review.

Velasquez EM, Anand RC, Newman WP 3rd, Richard SS, Glancy DL. Cardiovascular complications associated with cocaine use. J La State Med Soc. 2004 Nov-Dec;156(6):302-10; quiz 311. Review.

Lucas CE. The impact of street drugs on trauma care. J Trauma. 2005 Sep;59(3 Suppl):S57-60; discussion S67-75.