Cerebral Vasculitis Associated With Cocaine Abuse or Subarachnoid Hemorrhage?

To the Editor. —Kaye and Fainstat¹ report a case of alleged cerebral vasculitis secondary to cocaine use. Their interpretation is difficult to accept. The patient experienced unilateral headache and blurred vision for six days, left hemiparesis, drowsiness, and fever for four days, and then a major motor seizure. The cerebrospinal fluid was bloody and did not clear from the first to the fourth tube; the supernatant apparently was not examined for xanthochromia. An angiogram showed irregular narrowing of the right supraclinoid internal carotid and proximal middle cerebral arteries and occlusion of the right anterior cerebral artery; the appearance of more distal vessels or of the left cerebral circulation was not described. A computed tomographic scan showed right cerebral infarction.

It seems to us that this patient probably had a subarachnoid hemorrhage that was followed four days later by cerebral vasospasm and infarction. Lack of visible blood on the computed