Intracranial aneurysms and cocaine abuse: Analysis of prognostic indicators

OBJECTIVE: The outcome of subarachnoid hemorrhage associated with cocaine a buse is reportedly poor. However, no study in the literature has reported t he use of a statistical model to analyze the variables that influence outco me. METHODS: A review of admissions during a 6-year period revealed 14 patients with cocaine-related aneurysms. This group was compared with a control gro up of 135 patients with ruptured aneurysms and no history of cocaine abuse. Age at presentation, time of ictus after intoxication, Hunt and Hess grade of subarachnoid hemorrhage, size of the aneurysm, location of the aneurysm , and the Glasgow Outcome Scale score were assessed and compared. RESULTS: The patients in the study group were significantly younger than th e patients in the control group (P < 0.002). In patients in the study group , all aneurysms were located in the anterior circulation. The majority of t hese aneurysms were smaller than those of the control group (8 +/- 6.08 mm versus 11 +/- 5.4 mm; P = 0.05). The differences in mortality and morbidity between the two groups were not significant. Hunt and Hess grade (P < 0.00 5) and age (P < 0.007) were significant predictors of outcome for the patie nts with cocaine-related aneurysms. CONCLUSION: Cocaine use predisposed aneurysmal rupture at a significantly e arlier age and in much smaller aneurysms. Contrary to the published literat ure, this group did reasonably well with aggressive management.