Neuropathological alterations in cocaine abuse.

Cocaine abuse represents a significant health issue worldwide. Besides cardiovascular complications, psychiatric and neurologic symptoms are the most common manifestations of cocaine toxicity. In cocaine abusers brain abnormalities have been shown with computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), or single photon emission computed tomography (SPECT). The spectrum of neuropathologic alterations seen in cocaine abusers is broad. The major findings consist of vascular complications such as stroke, subarachnoid and intracerebral hemorrhages and cerebral ischemia. Persons with underlying arteriovenous malformation or aneurysm are especially prone for such events. Except for a few incidents of vasculitis, the etiology of cocaine- related cerebrovascular events is still unclear. Cocaine-induced vasospasm, impaired hemostasis and platelet function, as well as decreased cerebral blood flow, have been proposed as possible mechanisms. On the molecular level, alterations in the expression of transcription factors and changes of brain neurotransmitter systems have been reported.