Drug Induced Vasculitis Including Illicit Drugs

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Some drugs, such as chemotherapeutic agents (e.g. sulfonamide, thiouracil) and illicit drugs (e.g. cocaine), can cause vasculitis [26]. Stroke can occur soon after administration of illicit drugs by an intravenous, oral or nasal route. Cocaine, heroin, amphetamine and other sympathomimetic drugs are most commonly implicated. The diagnosis of "vasculitis" depends on the pathological findings, not on the an-giographic findings, which are usually non-specific and may simply indicate vasospasm induced by these drugs.

Cocaine use has emerged as an important cause of cerebrovascular events in young adults [27]. Vas-culitic changes can be present on angiography, but the significance of these changes has been debated. However, elevated sedimentation rate and biopsy changes of vasculitis have been documented. MR angiography may reveal irregularity of the intracerebral vessels and DW imaging is useful for the detection of acute ischemic changes (Fig. 7.10).

Cytotoxic Edema

Figure 7.10 a-c

Cocaine-induced vasculopathy in a 41-year-old man with dysarthria. a T2-weighted image shows bilateral hyperintense lesions in medial thalami (arrows). b DW image shows the lesion in the right thalamus as hyperintense, indicating an acute infarct. c MR angiography shows stenosis of the right posterior cerebral artery (arrow). Biopsy was not performed and therefore the term cocaine-induced vasculopathy was used. (From [49])

Cocaine VasculopathyGiant Cell Arteritis Mri

Figure 7.10 a-c

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