To the Editor.
—We were intrigued by the hypothesis proposed by Deringer et al1 in their letter that appeared in the May issue of the Archives. The possibility of very delayed-onset stroke following cocaine abuse would of course effect a major change in our thinking about the abuse potential, serious consequences, and medical care of the casual and regular cocaine abuser.In our series of 15 cases,2 as well as in other reports of cocaine-related strokes,3,4 infarcts occurred within a few hours following cocaine abuse or in some cases on awaking in the morning following a "binge" the night before. Based on the various pathophysiologic effects of cocaine on the cardiovascular system several mechanisms have been proposed, none of which can explain a cerebral infarct as late as 6 months after the last use of cocaine. In addition all of our patients had tested positive for cocaine
Tuchman AJ, Daras M. Strokes Associated With Cocaine Use. Arch Neurol. 1990;47(11):1170. doi:10.1001/archneur.1990.00530110024007
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