Neurologic complications of cocaine.

Coca leaves have been chewed by South American Indians for several centuries, and cocaine hydrochloride (HCl) has been used since it was isolated in the middle of the 19th century by Niemann (Grinspoon and Bakalar 1981; Holmstedt and Fredga 1981; Petersen 1977). However, untoward effects related to the chewing of the leaves or intranasal insufflation of cocaine HCl had been rare. When used for the only remaining medical indication, local anesthesia, complications are uncommon. In a survey of over 100,000 rhinoplasties performed using cocaine HCl as a local anesthetic, 191 mild and 34 severe reactions were reported, and 5 deaths were attributed to its use (Feehan and Mancusi-Ungaro 1976).