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Hyperdense Basilar Artery Sign in a Young Cocaine User: A Rare Presentation of Stroke
Sinal da artéria basilar hiperdensa em um jovem usuário de cocaína: uma apresentação rara de acidente vascular cerebral
Signo hiperdenso de la arteria basilar en un joven consumidor de cocaína: una rara manifestación de accidente cerebrovascular
1WEBIMAGEM Telerradiologia. São Paulo-SP, Brasil. Correo eletrónico: bruno_brehme@hotmail.com.
2Universidade do Oeste Paulista, Campus Guarujá. Guarujá-SP, Brasil. Correo eletrónico: natannascimento1601@gmail.com.
3Universidade Federal de São Paulo. Santos-SP, Brasil. Correo eletrónico: mayara2112@hotmail.com.
4Instituto de Análises Clínicas de Santos. Santos-SP, Brasil. ; Correo eletrónico: bilita88@gmail.com
5Universidade de Ribeirão Preto, Campus Guarujá. Guarujá-SP, Brasil. Diagnósticos da América S.A., São Paulo-SP, Brasil. Correo eletrónico: marcioluisduarte@gmail.com.
Abstract
Cocaine use is a well-documented factor in both ischemic and hemorrhagic stroke; however, basilar artery thrombosis due to cocaine use is rare, with few cases reported in the literature. As a widely used illicit drug, cocaine can trigger acute basilar artery thrombosis, leading to severe neurological outcomes. The mechanisms involved include cerebral vasospasm, platelet aggregation, thrombosis, cerebral vasculitis, and thromboembolism resulting from cardiomyopathy or drug-induced arrhythmias. We report the case of a 30-year-old man with recurrent seizures following cocaine use.
Keywords: Ischemic Stroke; Tomography, X-Ray Computed; Cocaine
Resumo
O uso de cocaína é um fator bem documentado para acidentes vasculares cerebrais (AVC) isquêmicos e hemorrágicos, embora a trombose da artéria basilar causada por cocaína seja rara, com poucos casos descritos na literatura. Como uma droga ilícita amplamente utilizada, a cocaína pode desencadear trombose aguda da artéria basilar, resultando em desfechos neurológicos graves. Os mecanismos envolvidos incluem vasoespasmo cerebral, agregação plaquetária, trombose, vasculite cerebral e tromboembolismo devido a cardiomiopatia ou arritmias induzidas pela droga. Relatamos o caso de um homem de 30 anos com convulsões recorrentes após o uso de cocaína.
Palavras-chave: AVC Isquêmico; Tomografia Computadorizada por Raios X; Cocaína
Resumen
El uso de cocaína es un factor bien documentado en los accidentes cerebrovasculares (ACV) isquémicos y hemorrágicos; sin embargo, la trombosis de la arteria basilar debido al uso de cocaína es rara, con pocos casos descritos en la literatura. Como droga ilícita ampliamente utilizada, la cocaína puede desencadenar una trombosis aguda de la arteria basilar, resultando en graves consecuencias neurológicas. Los mecanismos involucrados incluyen vasoespasmo cerebral, agregación plaquetaria, trombosis, vasculitis cerebral y tromboembolismo debido a cardiomiopatía o arritmias inducidas por la droga. Presentamos el caso de un hombre de 30 años con convulsiones recurrentes después del uso de cocaína.
Palabras clave: Accidente Cerebrovascular Isquémico; Tomografía Computarizada por Rayos X; Cocaína.
A 30-year-old man had a seizure 30 minutes ago. He developed decreased consciousness associated with recurrent seizures, coarse limb tremors, and fever unresponsive to antipyretics. He is a cocaine user and had been abusing it before the seizures. Axial cranial computed tomography (CT) scan shows a hyperdense artery sign in the basilar artery (Figure 1 A ), and sagittal CT angiography (CTA) detects a filling defect in the basilar artery due to contrast, diagnosing basilar artery thrombosis (Figures 1 B-D ). After imaging, he progressed to loss of oculocephalic reflex, corneal reflex, ciliospinal reflex, and no motor response to painful stimuli. One hour later, in the intensive care unit (ICU), he presented decorticate posturing followed by decerebrate posturing. One day later, the patient died in the ICU.
The hyperdense artery sign is indicative of thrombosis.1 This sign in the basilar artery is rare and has a poor prognosis. (1 Although ischemic stroke in young people is relatively rare, cocaine use is a well-established risk factor and involves multiple interconnected mechanisms. (2 Cocaine use can elevate blood pressure, triggering hypertensive crises and increasing the risk of cerebral hemorrhage.3 It also induces vasospasm, which can cause ischemia and subsequent hemorrhage when relieved. (3 Additionally, cocaine disrupts vascular endothelium and alters blood coagulation, making vessels prone to rupture. (3 These mechanisms elevate the risks of both hemorrhagic and ischemic strokes, with platelet aggregation further contributing to ischemic events. (4
References:
1. MacEwen C, Ward M, Buchan A. A case of cocaine-induced basilar artery thrombosis. Nat Clin Pract Neurol. 2008 Nov;4(11):622-6. doi: 10.1038/ncpneuro0879.
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2. Agarwal A, Bathla G, Kanekar S. Imaging of Non-atherosclerotic Vasculopathies. J Clin Imaging Sci. 2020 Oct 13;10:62.
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3. Rendon LF, Malta S, Leung J, Badenes R, Nozari A, Bilotta F. Cocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence. J Clin Med. 2023 Aug 10;12(16):5207. doi: 10.3390/jcm12165207.
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4. Alqahtani SA, Burger K, Potolicchio S. Cocaine-Induced Acute Fatal Basilar Artery Thrombosis: Report of a Case and Review of the Literature. Am J Case Rep. 2015 Jun 25;16:393-7. doi: 10.12659/AJCR.894565.
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