Which neurologic and psychiatric findings suggest cocaine toxicity?

Updated: Sep 01, 2018
  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Sage W Wiener, MD  more...
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Answer

Altered sensorium and acute seizures are the most common cocaine-associated neurologic syndromes observed in the ED, accounting for 52% of related presentations. Other cocaine-related neurologic processes are toxic encephalopathy, ischemic and hemorrhagic stroke, neurogenic syncope, and movement disorders. Use of cocaine also decreases rapid eye movement (REM) sleep.

Seizures, which can produce hyperthermia and lactic acidosis, are aassociated with increased risk of lethality.

About 3-4% of all strokes occur in patients aged 15-45 years. Cocaine is a common cause of stroke in young patients. Cocaine-induced hypertension may lead to hemorrhage from a cerebral aneurysm or ruptured arteriovenous malformation (AVM).

Extrapyramidal phenomena and other movement disorders, though uncommon, are reported in association with cocaine use. These effects are collectively referred to as "crack dancing." In a patient without a history of neuroleptic use such a presentation may be confusing to the ED physician.

Headaches, some potentially resulting from inhibited serotonin reuptake, are common in people who use cocaine, whereas cerebral vasculitis is rare.


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