Objective:

To describe cases of multiple territory ischemic stroke in young individuals secondary to combined cocaine and heroin use.

Background:

Abuse of cocaine and heroin has been linked to ischemic stroke via various mechanisms. Cocaine use can lead to vasospasm, direct cerebral vessel damage, or other end-organ damage which can promote clot formation. Heroin use has been linked to hypoxic-ischemic injury, promoting cardioembolism, and rarely hypereosinophilia. The effects of a combination of these two substances on acute ischemic stroke are less frequently reported.

Design/Methods:

Results:

Case 1: A 37-year-old female with a history of polysubstance use disorder presented after being found down. She was disoriented, confabulating, had ataxia and dysarthria with a NIHSS of 15. MRI revealed symmetric ischemic changes within the bilateral hippocampi, bilateral cerebellar regions, and right occipital lobe. The patient endorsed use of synthetic heroin and cocaine prior to presentation. Case 2: A 46-year-old male presented after being found down in a hotel room with an empty syringe, later endorsing combined cocaine and heroin use. On exam, he was severely obtunded and required intubation, NIHSS was 27. MRI revealed symmetric ischemic changes in the bilateral globus pallidus, centrum semiovale, corona radiata, and scattered foci of restricted diffusion in both cerebral hemispheres. Case 3: A 46-year-old male with a history of type 2 diabetes mellitus and polysubstance use disorder presented with a 5-day history of altered mental status. Exam notable for apraxia, short term memory loss, and shuffling gait, but NIHSS was 0. Use of cocaine and heroin was identified. MRI revealed bilateral globus pallidus infarcts with petechial hemorrhage, and a right temporal lobe infarct. 

Conclusions: