Abstract

Erythroxylum coca (cocaine) is a Class A drug within the UK. It has a current prevalence rate of 2.1% in the adult population, more commonly amongst young adults. Although it was favoured amongst physicians in the 19th century, its pharmacological properties are now known to have many clinical adverse effects. We present a 30-year-old, normally fit, patient who attended A and E twice with a history of occipital headache and vomiting following an alcohol binge, but with no history of trauma. He admitted to an extensive history of cocaine abuse. Examination revealed bilateral papilloedema. Imaging confirmed a superior sagittal and transverse sinus thrombosis. Cocaine- induced central venous thrombosis was diagnosed. He was managed with routine anticoagulation and a repeat MRV showed re-cannulation of the vessels. There is a well-documented link between cocaine use and arterial thrombosis. However the literature on venous thrombosis is limited to few papers about DVT and injection of cocaine, and in-vitro studies of the prothrombotic properties of cocaine. We feel this case study will add to the limited database of this neurological complication of cocaine. It highlights the importance of taking a thorough history, including illicit drug use, for any patient presenting with headache. It enables us to inform patients about the risks of regular misuse. Finally it raises questions about the on-going management of patients following cocaine-induced thrombotic events, who continue to expose themselves to cocaine and it's prothrombotic properties.