CASE HISTORY – March 2023

Cocaine-induced spinal cord transient ischaemic attack

Authors: Triin Helin Unt

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Compared with ischaemic disorders of the brain, ischaemic lesions of the spinal cord are rare due to extensive blood vessel anastomoses in the spinal cord. Traditional factors for stroke risk may be absent in most cases. Since the introduction of crackcocaine in the 1980s, the number of neurovascular complications after cocaine use has also increased, including rarely occurring ischaemic lesion of the spinal cord. The etiology of cocaine-induced ischaemia is unclear, but the proposed pathophysiology includes vasculitis, increased aggregation of platelets, cardiogenic embolism due to ventricular fibrillation, as well as sympathomimetic neurotransmitter reuptake blockage. Regardless of the pathogenetic mechanism, cocaine consumption should be suspected in the case of ischaemic event in young persons. In addition to radiological and cardiovascular investigations, the toxicological screening of urine can help identify such cases.