THE INCIDENCE OF ACUTE COCAINE OR METHAMPHETAMINE INTOXICATION IN DEATHS DUE TO RUPTURED CEREBRAL (BERRY) ANEURYSMS

Acute intoxication with either cocaine or methamphetamine may contribu te to formation and rupture of a berry aneurysm by causing transient h ypertension and tachycardia. We report the results of a retrospective study to determine the incidence of acute cocaine or methamphetamine i ntoxication in deaths due to ruptured berry aneurysm in our jurisdicti ons. We reviewed all deaths from ruptured cerebral aneurysms that fell within our jurisdictions during the seven years from 1 January 1987 t o 31 December 1993 and found 83 cases. The mechanism of death invariab ly involved subarachnoid hemorrhage, although some cases also had intr acerebral hemorrhage. A history of drug abuse was found in 13 cases. T oxicological analysis was performed in 39 cases. Of these methamphetam ine was detected in six cases and cocaine in three cases-an incidence of 21%. (In one case both methamphetamine and cocaine were detected.) The incidence of acute cocaine intoxication in all autopsies in Jeffer son County was 13.6%. The incidence of methamphetamine intoxication in all autopsies in San Diego County was 4.9%. Although the exact mechan ism by which berry aneurysms form remains undetermined, research indic ates that propagation and rupture of the aneurysm are aggravated by hy pertension and tachycardia, both of which are pharmacologic side effec ts of cocaine and methamphetamine. Based on the preponderance of metha mphetamine associated with deaths due to ruptured berry aneurysms it a ppears that methamphetamine is more toxic than cocaine, perhaps owing to the longer half-life of methamphetamine.