Intracerebral haemorrhage in young adults: the emerging importance of drug misuse

The growing pandemic of cocaine use in Western society is providing increasing evidence of its association with intracerebral haemorrhage. In this week's BMJ, Andrew McEvoy and colleagues at the National Hospital for Neurology and Neurosurgery in London, warn doctors to be alert both for drug misuse and an underlying vascular cause in cases of young patients with haemorrhagic stroke.

The authors report that in 13 recent cases of young (average age 31 years) stroke patients who had misused illegal drugs, nine out of ten of those investigated had underlying vascular problems, including six with intracranial aneurysm.

Despite the widespread use of ecstasy, acute neurological complications from it seem to be rare, but cocaine and amphetamine misuse are both well recognised causes of intracerebral and subarachnoid haemorrhage. The mortality and morbidity of patients who suffer a stroke after drug misuse is known to be appreciably greater than for similar patients who do not misuse drugs. The authors recommend that a through medical history, focusing on the use of illegal drugs, plus blood and urine tests, should be part of the evaluation of any young patient with stroke.

Contact:

A W McEvoy, University Department of Neurosurgery, Institute of Neurology National Hospital for Neurology and Neurosurgery, London WC1N 3BG

Email: a.mcevoy@ion.ucl.ac.uk