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Neurologic Effects of Cocaine Clinical Presentation

  • Author: Pinky Agarwal, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
Updated: Dec 15, 2015


Acute effects 

Acute effects of cocaine use include the following:

  • Decreased food intake
  • Increased activity
  • Effusiveness
  • Diminished fatigue

Long-term use

Long-term use of cocaine interferes with sleep, can lower seizure threshold, and lead to palatal perforation. 

Overdose of cocaine

Signs of a cocaine overdose include the following:

  • Convulsions
  • Hyperthermia
  • Coma

Neuropsychiatric complications

Psychiatric disturbances include depression, suicidal ideation, paranoia, kleptomania, violent antisocial behavior, catatonia, and auditory or visual hallucinations. Cocaine use may lead to impulsivity, resulting in sexually risky behavior and increasing the risk of becoming infected with HIV.

Headache is a relatively frequent symptom (3.5%) in cocaine users. Headaches occur in 11% of cocaine paste smokers.


Convulsions occur in about 1-40% of cocaine users.[10] Convulsions caused by cocaine can be generalized or partial, simple or complex. The majority of seizures are single, generalized, induced by intravenous or crack cocaine, and not associated with any lasting neurological deficits. Most focal, multiple, or induced seizures caused by nasal insufflation of cocaine are associated with an acute intracerebral complication or concurrent use of other drugs.

All routes of administration are associated with seizures, and seizures can be induced in some persons by small quantities of cocaine. Once intoxication has passed, these individuals do not require long-term anticonvulsant therapy.

Although most cocaine-induced seizures are benign and self-limiting, seizures may be due to other more severe complications, such as infarction and intracranial hemorrhage.

Renal failure

Cocaine can cause acute renal failure resulting from rhabdomyolysis or vasospasm.



A dose-dependent increase in heart rate and blood pressure can occur.

Contributor Information and Disclosures

Pinky Agarwal, MD Clinical Associate Professor, Department of Neurology, University of Washington School of Medicine; Attending Neurologist, Medical Director, Booth Gardner Parkinson's Care Center

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, International Parkinson and Movement Disorder Society

Disclosure: Nothing to disclose.


Souvik Sen, MD, MPH, MS, FAHA Professor and Chair, Department of Neurology, University of South Carolina School of Medicine

Souvik Sen, MD, MPH, MS, FAHA is a member of the following medical societies: American Academy of Neurology, Association for Patient-Oriented Research, American Heart Association

Disclosure: Nothing to disclose.

Sindhu R Srivatsal, MD, MPH Fellow in Movement Disorders, Department of Neurology, University of Washington School of Medicine; Acting Instructor, Veterans Affairs Puget Sound Healthcare Systems

Sindhu R Srivatsal, MD, MPH is a member of the following medical societies: American Academy of Neurology, International Parkinson and Movement Disorder Society, Washington State Neurological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Edward L Hogan, MD Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina

Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, Society for Neuroscience, American Society for Biochemistry and Molecular Biology, American Academy of Neurology, American Neurological Association, Phi Beta Kappa, Sigma Xi, Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

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