Fatal stroke in a young cocaine drug addict: chemical hair analysis and cervical artery examination twenty months after death

摘要

Introduction Cocaine use has been associated with ischaemic stroke due to vasospasm of large arteries and secondary intravascular thrombosis [6,9]. Exposure to cocaine is usually demonstrated by urine toxicological analysis; however, this analysis is not routinely performed in young stroke victims. We present a case of a young female who developed a progressive and fatal stroke. Twenty months post-mortem, toxicological analysis in a forensic exhumation autopsy showed cocaine in hair samples. Moreover, targeted artery sampling for histological examination was performed. The results of histological examination appeared to be helpful in demonstrating the putative anatomic site of vascular damage responsible for the stroke. Case report A 26-year-old female with an unremarkable medical history developed a persistent headache and heaviness of her right arm. The patient arrived at the Emergency Department of a local hospital about 24 hours later. Clinical examination revealed minor lower facial weakness and slight drift of the right upper arm when extended. Neurological examination was otherwise normal. Head CT scan demonstrated a focal hypodensity of the head of the caudate nucleus, probably related to recent ischaemic parenchymal damage (Fig. 1A, arrow). Chest x-ray and electrocardiogram were normal. Routine laboratory tests disclosed mild leukocytosis. No drug screening was performed. The patient was admitted to hospital and 16 hours later her neurological condition deteriorated rapidly. She became aphasic and presented severe motor deficit of the right upper limb and slight motor deficit of the right lower limb. Anti-oedema (glycerol), anti-inflammatory (dexamethasone), and anti-coagulant (enoxaparin) treatments were rapidly done. Furosemide was administered because of a slight increase in blood pressure. A new CT scan showed a large shaded area of hypodensity in the left frontal lobe with involvement of the adjacent basal ganglia region (Fig. 1B); both the rapid evolution of the lesion and the morphology of the involved cerebral areas suggested a diagnosis of recent ischaemic infarct in the vascular territory of the left carotid artery. Colour Doppler examination revealed a complete obstruction at the beginning of the left internal carotid artery. After a few hours, the patient lapsed into a coma and was transferred to the intensive care unit. She died shortly thereafter. On the death certificate, the cause of death... View full text...