Current concepts of cerebrovascular disease--stroke: stroke and drug abuse.

DRUG abuse is a very serious problem. Because of man's search for new and different ways of inducing pleasurable feelings, the number of available pharmaceuticals has grown exponentially during the last few decades, as has societal use and dependence on medicines. Clearly, increased use has led to frequent abuse. Physicians should be aware of the many facets of drug abuse. It is now clear that drug abuse is a significant cause of stroke, especially in young adults and adolescents. Addicts frequently abuse more than one substance. Furthermore, the drugs are mixed with a variety of different diluents and usually injected without sterile precautions. Drugs may be taken orally, inhaled nasally, or injected subcutaneously or intravenously. Drug abusers do not always honestly report the details of their usage, and they do not always appear for followup evaluations. As a result it is difficult to assess the role of an individual agent or adulterant and to determine the effect of dosage, foreign body or infectious contamination, avenue of entry, or incidence of longterm sequelae. Neurologists have only recently been active in the clinical or laboratory study of drug abuse so that information on neurological complications of many of the drugs used is fragmentary and incomplete. This review will summarize available information concerning cerebral vascular complications of the most commonly abused substances (Table 1) and discuss possible mechanisms of vascular injury and cerebral damage. Although alcohol is frequently abused and may have important cerebrovascular effects, its consideration is beyond the scope of this review.