Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Neurologic Effects of Cocaine Clinical Presentation

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

History

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

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.

Next

Physical

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

Previous
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
  1. Freud S. Uber Coca.Neu durchgesehener und vermehrter Separat-Abdruck aus dem Centralblatt fur die gesamte Therapie, II. Vienna: Verlag von Moritz Perles; 1884-1885. 289-314.

  2. Haile CN, Mahoney JJ 3rd, Newton TF, De La Garza R 2nd. Pharmacotherapeutics directed at deficiencies associated with cocaine dependence: focus on dopamine, norepinephrine and glutamate. Pharmacol Ther. 2012 May. 134(2):260-77. [Medline].

  3. elSohly MA, Brenneisen R, Jones AB. Coca paste: chemical analysis and smoking experiments. J Forensic Sci. 1991 Jan. 36(1):93-103. [Medline].

  4. Arora NP. Cutaneous vasculopathy and neutropenia associated with levamisole-adulterated cocaine. Am J Med Sci. 2013 Jan. 345(1):45-51. [Medline].

  5. Lee KC, Ladizinski B, Federman DG. Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge. Mayo Clin Proc. 2012 Jun. 87(6):581-6. [Medline].

  6. Pozzi M, Roccatagliata D, Sterzi R. Drug abuse and intracranial hemorrhage. Neurol Sci. 2008 Sep. 29 Suppl 2:S269-70. [Medline].

  7. Chang TR, Kowalski RG, Caserta F, Carhuapoma JR, Tamargo RJ, Naval NS. Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage. Stroke. 2013 Jul. 44(7):1825-9. [Medline].

  8. Harzke AJ, Williams ML, Bowen AM. Binge Use of Crack Cocaine and Sexual Risk Behaviors Among African-American, HIV-Positive Users. AIDS Behav. 2008 Aug 30. [Medline]. [Full Text].

  9. Grov C, Kelly BC, Parsons JT. Polydrug use among club-going young adults recruited through time-space sampling. Subst Use Misuse. 2009. 44(6):848-64. [Medline]. [Full Text].

  10. Zagnoni PG, Albano C. Psychostimulants and epilepsy. Epilepsia. 2002. 43 Suppl 2:28-31. [Medline].

  11. Venkatratnam A, Lents NH. Zinc reduces the detection of cocaine, methamphetamine, and THC by ELISA urine testing. J Anal Toxicol. 2011 Jul. 35(6):333-40. [Medline].

  12. Warner TD, Behnke M, Eyler FD, et al. Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children. Pediatrics. 2006. 118(5):2014-24. [Medline].

  13. Tumeh SS, Nagel JS, English RJ, Holman BL. Cerebral abnormalities in cocaine abusers: demonstration by SPECT perfusion brain scintigraphy. Work in progress. Radiology. 1990 Sep. 176(3):821-4. [Medline].

  14. Leung IY, Lai S, Ren S, Kempen J, Klein R, Tso MO, et al. Early retinal vascular abnormalities in African-American cocaine users. Am J Ophthalmol. July/2008. 146(4):612-619. [Medline]. [Full Text].

  15. Schierenberg A, van Amsterdam J, van den Brink W, Goudriaan AE. Efficacy of contingency management for cocaine dependence treatment: a review of the evidence. Curr Drug Abuse Rev. 2012 Dec. 5(4):320-31. [Medline].

  16. Haile CN, De La Garza R 2nd, Mahoney JJ 3rd, Nielsen DA, Kosten TR, Newton TF. The impact of disulfiram treatment on the reinforcing effects of cocaine: a randomized clinical trial. PLoS One. 2012. 7(11):e47702. [Medline].

  17. Nejtek VA, Avila M, Chen LA, Zielinski T, Djokovic M, Podawiltz A, et al. Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial. J Clin Psychiatry. Aug/2008. 69(8):1257-66. [Medline]. [Full Text].

  18. Jobes ML, Ghitza UE, Epstein DH, Phillips KA, Heishman SJ, Preston KL. Clonidine blocks stress-induced craving in cocaine users. Psychopharmacology (Berl). 2011 Nov. 218(1):83-8. [Medline].

  19. Shoptaw S, Heinzerling KG, Rotheram-Fuller E, Kao UH, Wang PC, Bholat MA, et al. Bupropion hydrochloride versus placebo, in combination with cognitive behavioral therapy, for the treatment of cocaine abuse/dependence. J Addict Dis. 2008. 27(1):13-23. [Medline].

  20. Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. Ann Emerg Med. Feb2008. 51(2):117-25. [Medline].

  21. McCord J, Jneid H, Hollander JE, de Lemos JA, Cercek B, Hsue P. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008 Apr 8. 117(14):1897-907. [Medline].

  22. Martell BA, Orson FM, Poling J, Mitchell E, Rossen RD, Gardner T, et al. Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Arch Gen Psychiatry. 2009 Oct. 66(10):1116-23. [Medline].

  23. Lason W. Neurochemical and pharmacological aspects of cocaine-induced seizures. Pol J Pharmacol. 2001 Jan-Feb. 53(1):57-60. [Medline].

  24. Bianco F, Iacovelli E, Tinelli E, Lepre C, Pauri F. Recurrent leukoencephalopathy in a cocaine abuser. Neurotoxicology. 2011 Aug. 32(4):410-2. [Medline].

  25. Zhou W, Lin PH, Bush RL, et al. Acute arterial thrombosis associated with cocaine abuse. J Vasc Surg. 2004 Aug. 40(2):291-5. [Medline].

  26. Brody SL, Slovis CM, Wrenn KD. Cocaine-related medical problems: consecutive series of 233 patients. Am J Med. 1990 Apr. 88(4):325-31. [Medline].

  27. Amin M, Gabelman G, Karpel J, Buttrick P. Acute myocardial infarction and chest pain syndromes after cocaine use. Am J Cardiol. 1990 Dec 15. 66(20):1434-7. [Medline].

  28. McCord J, Jneid H, Hollander JE, de Lemos JA, Cercek B, Hsue P. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008 Apr 8. 117(14):1897-907. [Medline].

  29. Chang AM, Walsh KM, Shofer FS, et al. Relationship Between Cocaine Use and Coronary Artery Disease in Patients With Symptoms Consistent With an Acute Coronary Syndrome. Acad Emerg Med. 2010 Dec 23. [Medline].

  30. MacDonald S, Mann R, Chipman M, Pakula B, Erickson P, Hathaway A, et al. Driving behavior under the influence of cannabis or cocaine. Traffic Inj Prev. 2008. 9(3):190-4. [Medline].

  31. Bendersky M, Bennett D, Lewis M. Aggression at Age 5 as a Function of Prenatal Exposure to Cocaine, Gender, and Environmental Risk. J Pediatr Psychol. 2005 Apr 12. [Medline].

  32. Brewer JD, Meves A, Bostwick JM, Hamacher KL, Pittelkow MR. Cocaine abuse: dermatologic manifestations and therapeutic approaches. J Am Acad Dermatol. 2008 Sep. 59(3):483-7. [Medline].

  33. Dackis CA, Kampman KM, Lynch KG, et al. A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology. 2005 Jan. 30(1):205-11. [Medline].

  34. Fiellin DA, Pantalon MV, Chawarski MC, et al. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med. 2006 Jul 27. 355(4):365-74. [Medline].

  35. Gillman MA, Lichtigfeld FJ, Harker N. Psychotropic analgesic nitrous oxide for acute cocaine withdrawal in man. 1: Int J Neurosci. 2006. 116(7):847-57. [Medline].

  36. Halkitis PN, Palamar JJ. Multivariate modeling of club drug use initiation among gay and bisexual men. Subst Use Misuse. 2008. 43(7):871-9. [Medline].

  37. Hayaki J, Anderson B, Stein M. Sexual risk behaviors among substance users: relationship to impulsivity. Psychol Addict Behav. 2006. 20(3):328-32. [Medline].

  38. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006. 108(4):1005-16.

  39. Rivero M, Karlic A, Navaneethan SD, Singh S. Possible cocaine-induced acute renal failure without rhabdomyolysis. J Nephrol. Jan-Feb;. 2006. 19(1):108-10. [Medline].

  40. Sofuoglu M, Kosten TR. Novel approaches to the treatment of cocaine addiction. CNS Drugs. 2005. 19(1):13-25. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.