Intracranial Hemorrhage After Cocaine Abuse

To the Editor.— Cocaine abuse and its medical, psychiatric, and neurological complications have been well documented.1 However, the incidence of intracranial hemorrhage in cocaine abuse must be exceedingly low, as only three cases have been reported in the American literature2,3 despite a large and growing population of cocaine abusers.Use of "crack," a new and more potent form of cocaine, has recently reached epidemic proportions in many major cities, especially New York.4 To our knowledge, no reports of intracranial hemorrhage associated with its abuse have been reported.In a two-week period, we evaluated five men aged 21 to 40 years with intracranial hemorrhage, one subsequent to confirmed abuse of crack, taken intravenously, one following intravenous cocaine abuse, and three with cocaine present in large amounts in their urine. Three of the patients had large intracerebral hematomas and two had subarachnoid hemorrhages. Two of the patients subsequently died,