Combined amphetamine and cocaine abuse caused mesencephalic ischemia in a 16-year-old boy - due to vasospasm?

Both the relationship between cocaine or amphetamine abuse and stroke as well as the pathomechanism of cocaine/amphetamineinduced stroke are still unclear. Whereas a recent study showed no association between cocaine abuse and ischemic stroke in young patients [1], others have described cocaineor amphetamine-related strokes [2–5]. Several pathomechanisms have been discussed in the literature: cocaine-associated cerebral vasculitis [6], cocaine-associated cardiomyopathy leading to embolic stroke [2, 7, 8] or vasospasm [3]. We report on a young patient who used both drugs and subsequently suffered an ischemic lesion, which was most likely caused by vasospasm due to the combined abuse of both drugs.