1. By Shantanu Pisharoty and Omeshwari Devi Chudasama

2. General effects of cocaine  Neuropsychiatric- suicidal behaviours, violent psychoses, strokes, seizures and encephalopathies.  CVS High doses can produce massive myocardial necrosis and unstable angina even in young adults not predisposed to cvs disorders Low doses can produce malignant arrhythmias.

3.  Kidneys Acute renal failure is a serious complication of cocaine overdose. The kidney shutdown might be secondary to massive muscle necrosis and myoglobinemia.  Gestational the fetal effects of cocaine have included autonomic hyper arousal, delayed CNS development and attentional deficits after birth.

4.  Neurovascular  cerebrovascular accidents,CNS vasculitis and encephalopathies. Ischemic or hemorrhagic strokes can occur within three hours of cocaine use. Cocaine provokes  neurological -seizures (partial or generalized) -Movement disorders in long-term cocaine users include resting tremors, stereotypy, dystonia and chorea.tration. -Physiologic tremors are worsened during sympathoadrenergic arousal but not during action or intention. -Unlike alcohol tremors, cocaine tremors are notassociated with cerebellar signs.

5. Acute psychiatric effects  cocaine include a brief "rush," excitability, hypervigilance and anxiety. Cocaine euphoria can positively reinforce drug-taking behavior. Cocaine can induce psychotic symptoms that have included delusions, hallucinations or both.  “In 55 patients who were consecutively admitted for cocaine treatment approximately 50% reported that they had experienced a short-lived psychosis.” Risk factors – male gender, dose and duration of usage

6.  Cocaine withdrawal is associated with negative affect states, such as apathy,anxiety, irritability, depression and suicidal thoughts.

7. Cognitive effects

8. Other studies  Transcranial Doppler (TCD) studies  The study reported a statistically significant brain perfusion deficit in the anterior and middle circulations among the chronic cocaine users but not among the control subjects.  Also, cocaine users showed an elevated cerebral vascular resistance as measured by the pulsatility index.  The reported pulsatility index was comparable to those of elderly patients at risk for cerebrovascular events and remained unchanged at one month of monitored abstinence, indicating that the deficits were probably due to the chronic effects of cocaine.

9.  Single photon emission computed tomography (SPECT) studies. The SPECT is a safe imaging technique that involves less expense and lower resolution than the positron emission tomographic (PET) scan.  The cocaine users showed significant hypoperfusion in the putamen and temporal cortex as compared to control subjects.  fewer brain perfusion abnormalities in women than in men who used cocaine on long-term basis.

10.  Magnetic resonance angiography (MRA).  Study-blood flow in healthy male volunteers aged 29 years who were administered with either 0.4 mg/kg or 0.2mg/kg of cocaine in a double-blind design.  The study provided direct evidence that cocaine-induced cerebral vasoconstriction in a dose-related was evident

11.  Diffusion Tensor Imaging (DTI)  The DTI is utilized to study the integrity of axonal microstructure and is based on directional flow properties of water in the axons.  results-  significant white-matter loss in the frontal lobe, implying a possible link between deranged connectivity and craving and decision-making deficits in these individuals.

12. Some things to remember  Cocaine should be considered in the diagnostic work up of strokes in young adults.  Cocaine-related, new-onset focal seizures in humans should prompt a search for cerebral hemorrhage

13. Thank you for your attention!!!

14. Bibliography  http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2594897/pdf/jnma00300- 0046.pdf?tool=pmcentrez