Abstract Details

Title Impact of Acute Cocaine Use on Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S12 - (-)

Poster/Presentation
Number 006

Objective

Background Acute cocaine use has been temporally associated with aSAH but there are varying reports describing how it affects patient presentation, complications, and outcomes.

Design/Methods Data of aSAH patients admitted to our institution between 1991-2009 were reviewed to determine which patients had used cocaine within 72 hours of aSAH based on positive urine toxicology or a history of cocaine use within 72 hours (C). These patients were then compared with aSAH patients without recent cocaine exposure (NC) in relation to their clinical and radiological presentations, complications such as DIND (delayed ischemic neurological deficit defined by vasospasm mediated cerebral infarcts) and outcomes defined by hospital mortality.

Results Data of 1134 patients were reviewed; aSAH in142 patients (12.5%) was associated with cocaine use. Cocaine users were more likely to be younger (mean age: C:49, NC:53, p<0.001). There was no significant difference in rates of poor grade Hunt & Hess (4/5) (C:21%; NC:26%, p>0.05), admission GCS <8 (C:17%, NC:18%, P>0.05), associated IVH (C:56%, NC:51%, p>0.05) or hydrocephalus on admission CT (C:49%; NC:52%, p> 0.05). Cocaine users were more likely to have vasospasm related infarcts when compared to non-cocaine users (C:22%; NC:16%, p<0.05) but after correcting for other factors impacting vasospasm, cocaine use was not independently associated with DIND. Cocaine users had higher rates of aneurysm re-rupture (C:7.7%, NC:2.7%, p0.004). Cocaine users were less likely to survive hospitalization compared to non-users following univariate analysis (Mortality: C:26%, NC:17%, p< 0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users following multivariate analysis (p<0.001).

Conclusions Acute cocaine use was associated with a higher risk of aneurysm re-rupture and hospital mortality. The various mechanisms for the nearly threefold increased odds of death associated with cocaine use warrants further investigation.

Authors/Disclosures
Tiffany Chang, MD PRESENTER	Dr. Chang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for National Football League.
Robert G. Kowalski, MBChB, MS (Harbor Hospital)	The institution of Dr. Kowalski has received research support from Henry Ford Hospital. The institution of Dr. Kowalski has received research support from MaxQ. Dr. Kowalski has a non-compensated relationship as a Editor-in-Chief, newsletter with PRe-hospital Stroke Treatment Organization (PRESTO) that is relevant to AAN interests or activities.
	No disclosure on file
Paul A. Nyquist, MD, MPH, FAAN (johns hopkins)	Dr. Nyquist has received personal compensation in the range of $500-$4,999 for serving as a Consultant for astra Zenneca. The institution of Dr. Nyquist has received research support from NIH.
Pratap R. Chand, MD, FRCP, FAAN (St Louis University School of Medicine)	Dr. Chand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. An immediate family member of Dr. Chand has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acorda. Dr. Chand has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva Neuroscience.
Juan R. Carhuapoma, MD (THe Johns Hopkins Hospital)	Dr. Carhuapoma has nothing to disclose.
Ali Seddighzadeh	No disclosure on file
	No disclosure on file
Neeraj Naval, MD (Lyerly Neurosurgery- Baptist Health)	No disclosure on file

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