Neurologic Effects of Cocaine Clinical Presentation

  • Author: Pinky Agarwal, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Mar 8, 2011
 

History

  • Acute effects of cocaine
    • Decreased food intake
    • Increased activity
    • Effusiveness
    • Diminished fatigue
  • Long-term cocaine use
    • Interferes with sleep
    • Can lower seizure threshold
    • Palatal perforation
  • Overdose of cocaine
    • 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.[6] 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.
  • Cocaine can cause acute renal failure resulting from rhabdomyolysis or vasospasm.
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Physical

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

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Contributor Information and Disclosures
Author

Pinky Agarwal, MD  Clinical Assistant Professor, Department of Neurology, University of Washington; Attending Neurologist, Booth Gardner Parkinson's Care Center, Kirkland, WA

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Movement Disorders 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, American Heart Association, and Association for Patient Oriented Research

Disclosure: NINDS Grant/research funds Research project; BMS/Sanofi Aventis Honoraria Speaking and teaching; Boehringer Ingelheim Honoraria Speaking and teaching

Specialty Editor Board

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, American Academy of Neurology, American Neurological Association, American Society for Biochemistry and Molecular Biology, Phi Beta Kappa, Sigma Xi, Society for Neuroscience, and Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Richard J Caselli, MD  Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale

Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

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, and Phi Beta Kappa

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

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

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

  5. 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].

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

  7. 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].

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

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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. Apr 8 2008;117(14):1897-907. [Medline].

  14. [Best Evidence] 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. Oct 2009;66(10):1116-23. [Medline].

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

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

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

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

  19. 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. Apr 8 2008;117(14):1897-907. [Medline].

  20. 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. Dec 23 2010;[Medline].

  21. 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].

  22. 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. Apr 12 2005;[Medline].

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

  24. Brown E, Prager J, Lee HY, Ramsey RG. CNS complications of cocaine abuse: prevalence, pathophysiology, and neuroradiology. AJR Am J Roentgenol. Jul 1992;159(1):137-47. [Medline].

  25. Brust JC. Clinical, radiological, and pathological aspects of cerebrovascular disease associated with drug abuse. Stroke. Dec 1993;24(12 Suppl):I129-33; discussion I134-5. [Medline].

  26. Chasnoff IJ, Bussey ME, Savich R, Stack CM. Perinatal cerebral infarction and maternal cocaine use. J Pediatr. Mar 1986;108(3):456-9. [Medline].

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

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

  29. 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].

  30. Green RM, Kelly KM, Gabrielsen T, et al. Multiple intracerebral hemorrhages after smoking "crack" cocaine. Stroke. Jun 1990;21(6):957-62. [Medline].

  31. 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].

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

  33. Jacobs IG, Roszler MH, Kelly JK, et al. Cocaine abuse: neurovascular complications. Radiology. Jan 1989;170(1 Pt 1):223-7. [Medline].

  34. Kaku DA, Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Ann Intern Med. Dec 1 1990;113(11):821-7. [Medline].

  35. Kaye BR, Fainstat M. Cerebral vasculitis associated with cocaine abuse. JAMA. Oct 16 1987;258(15):2104-6. [Medline].

  36. Killam AL. Cardiovascular and thrombosis pathology associated with cocaine use. Hematol Oncol Clin North Am. Dec 1993;7(6):1143-51. [Medline].

  37. Klonoff DC, Andrews BT, Obana WG. Stroke associated with cocaine use. Arch Neurol. Sep 1989;46(9):989-93. [Medline].

  38. Krendel DA, Ditter SM, Frankel MR, Ross WK. Biopsy-proven cerebral vasculitis associated with cocaine abuse. Neurology. Jul 1990;40(7):1092-4. [Medline].

  39. Levine SR, Brust JC, Futrell N, et al. A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride--a review. Neurology. Aug 1991;41(8):1173-7. [Medline].

  40. Mody CK, Miller BL, McIntyre HB, et al. Neurologic complications of cocaine abuse. Neurology. Aug 1988;38(8):1189-93. [Medline].

  41. Nalls G, Disher A, Daryabagi J, et al. Subcortical cerebral hemorrhages associated with cocaine abuse: CT and MR findings. J Comput Assist Tomogr. Jan-Feb 1989;13(1):1-5. [Medline].

  42. Nolte KB, Brass LM, Fletterick CF. Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study. Neurology. May 1996;46(5):1291-6. [Medline].

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

  44. Pascual-Leone A, Dhuna A, Altafullah I, Anderson DC. Cocaine-induced seizures. Neurology. Mar 1990;40(3 Pt 1):404-7. [Medline].

  45. 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].

  46. Rohsenow DJ, Monti PM, Martin RA, et al. Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes. Addiction. Jul 2004;99(7):862-74. [Medline].

  47. Roth ME, Carroll ME. Sex differences in the escalation of intravenous cocaine intake following long- or short-access to cocaine self-administration. Pharmacol Biochem Behav. Jun 2004;78(2):199-207. [Medline].

  48. Sanchez-Ramos JR. Psychostimulants. Neurol Clin. Aug 1993;11(3):535-53. [Medline].

  49. Sen S, Silliman SL, Braitman LE. Vascular risk factors in cocaine users with stroke. J Stroke Cerebrovasc Dis. 1999;8(4):254-258.

  50. Sloan MA, Kittner SJ, Rigamonti D, Price TR. Occurrence of stroke associated with use/abuse of drugs. Neurology. Sep 1991;41(9):1358-64. [Medline].

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

 
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