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Department of Neurology (Drs. Krendel, Ditter, and Frankel) and the Division of Neuropathology (Dr. Ross), Emory University School of Medicine, Atlanta, GA.
We report cerebral vasculitis in 2 cocaine users who developed symptoms (transient blindness and persistent headache) while smoking "crack," followed by progressive widespread cerebral dysfunction with focal signs over the next few weeks. One patient had smoked crack exclusively, and the other also used cocaine intravenously. Sedimentation rates were elevated and HIV titers negative. Arteriography was normal in 1 patient and in the other showed multiple large-vessel occlusions without beading. Brain biopsy showed vasculitis involving small vessels in both patients. Multinucleated cells were present in the neuropil, but there were no granulomas or evidence of infection. One patient improved significantly with corticosteroid treatment, and made a good recovery. The other died despite corticosteroid and cyclophosphamide treatment.
Address correspondence and reprint requests to Dr. David A. Krendel, Department of Neurology, The Emory Clinic, 1365 Clifton Road, N.E., Atlanta, GA 30322.
Received September 27, 1989. Accepted for publication in final form December 12, 1989.
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