Intracerebral haemorrhage and drug abuse in young adults

The epidemic of abuse of the so-called 'designer drugs' amphetamine, cocain e and ecstasy-is fast replacing traditional aetiological factors as the lar gest cause of intracerebral haemorrhage among young adults. Traditional tea ching is that these represent hypertensive haemorrhages. Recent reports, ho wever, have indicated that these patients may harbour underlying vascular m alformations. We review 13 patients with a positive history of drug abuse p receding the onset of intracerebral haemorrhage. These patients presented t o the National Hospital for Neurology and Neurosurgery in central London ov er a 7-month period. Of the 13 patients (eight male, five female), average age 31 years (19-43) years), 10 were well enough to undergo cerebral angiog raphy. Intracranial aneurysms were demonstrated in six patients and arterio venous malformations in three patients. In only one of the patients was the angiogram normal. A further patient was subsequently shown to have a middl e cerebral artery aneurysm at autopsy. The epidemiology, pharmacology and s ystemic effects of these drugs are considered. The mechanisms by which thes e compounds cause intracerebral complications and their influence on progno sis are discussed. The incidence of intracerebral haemorrhage (ICH), ischae mic cerebral infarctions and subarachnoid haemorrhage (SAH) following drug abuse is increasing. Contrary to historical opinion, drug-related ICH is fr equently related to an underlying vascular malformation. Arteriography shou ld be part of the evaluation of most young patients with nontraumatic ICH. A thorough history focusing on the use of illicit substances and toxicologi cal screening of urine and serum should be part of the evaluation of any yo ung patient with a stroke.