10 Mar Cocaine Use and Hemorrhagic Stroke
Hemorrhagic stroke, also known as an intracerebral or subarachnoid hemorrhage, is a condition that occurs in or near the brain when a blood vessel bursts open and spills its contents. In the general population, it occurs much less often than another form of stroke, called an ischemic stroke, but has a greater chance of producing fatal results. In cocaine-using populations, hemorrhagic strokes actually occur at least as frequently as ischemic strokes. Compared to people with hemorrhagic strokes who don’t use cocaine, people with this type of stroke who do use cocaine have increased chances of developing complications and dying.
Hemorrhagic Stroke Basics
Normal brain function is heavily dependent on the regular delivery of oxygen-rich blood to the brain’s tissues. If the blood flow to any portion of the brain drops significantly or ceases entirely for more than a few seconds at a time, the resulting lack of vital oxygen can trigger a die-off of locally affected brain cells, as well as the subsequent development of brain damage. This process is known generally as a stroke.
As indicated previously, hemorrhagic stroke occurs when one of the brain’s blood vessels bursts open and fails to deliver adequate amounts of oxygen-blood to the tissues it normally services. While some people have preexisting defects in their blood vessels that make this type of failure more likely, most people develop the problem for other reasons. Chief among these reasons is the presence of high blood pressure, a condition that occurs when the flow of blood during the active or resting phase of the heartbeat puts too much pressure on blood vessel walls and degrades their health.
Cocaine’s Effects on Blood Vessels
Most people are at least passingly familiar with cocaine’s ability to alter a person’s normal state of consciousness. This ability stems from the drug’s effects on the levels of an important substance in the central nervous system called dopamine. However, cocaine also has major effects on an involuntary nerve network in the body called the sympathetic nervous system, which produces rapid changes to normal body function in moments of extreme duress or physical danger. Essentially, cocaine artificially activates this system and brings it online when duress and danger are not present. One of the main effects of sympathetic nervous system activation is narrowing of the blood vessels, a process known medically as vasoconstriction. When this narrowing occurs on a large scale, it produces a significant increase in blood pressure.
In 2010, the American Heart Association and the American Stroke Association jointly released the results of a multi-year study that compared the rate and effects of hemorrhagic strokes in cocaine users to the rate and effects of the condition in people who don’t use cocaine. The authors of the study concluded that cocaine users experiencing a hemorrhagic stroke had unusually high blood pressure that contributed to the onset of their condition. Compared to people who don’t use cocaine, cocaine users also had degrees of hemorrhage that were significantly worse. Generally speaking, these hemorrhages tended to occur in the brainstem and other portions of the lower brain where high blood pressure typically has a greater negative effect on blood vessel health. However, cocaine users in the study also developed hemorrhages in the ventricular system, an area of the brain that produces cerebrospinal fluid; again, the hemorrhages in this system were usually worse than similarly located hemorrhages experienced by non-cocaine users.
While hemorrhagic strokes account for only roughly 8 to 18 percent of all strokes in the general population, they account for as many as half of all strokes among cocaine users.
Cocaine users who suffer a hemorrhagic stroke die about twice as frequently as non-cocaine users who suffer this type of stroke, the American Heart Association and the American Stroke Association report. Factors that probably contribute to this major difference in mortality rates include ongoing high blood pressure in habitual cocaine users and the tendency for cocaine users to develop hemorrhages in the brainstem and the ventricular system. Additional factors that may contribute to this difference include the specific chemical actions of cocaine within the brain and body, lack of adequate general healthcare in cocaine users, lack of high blood pressure treatment in cocaine users, and a tendency in some cocaine users to either avoid medical treatment or fail to comply with established treatment plans.
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