Cocaine-Induced Renal Artery Dissection as a Cause of Secondary Hypertension: A Rare Presentation

Abstract

Objective:Rare disease Background:Cocaine abuse is a globally recognized problem with great socioeconomic and health impacts on society. We report a case of dissection of vertebral arteries and right renal artery after cocaine abuse that clinically presented as atypical headache and hypertension. Case Report:A 36-year-old male sought emergency care due to cervical pain after cocaine abuse. The pain was located to the right cervical side with irradiation to the homolateral temporal region. He had no previous comorbidities, except for cocaine abuse on a weekly basis. Angiotomography showed alterations compatible with recent arterial dissection of the right vertebral artery, confirmed on angioresonance. The patient received double antiaggregation and antihypertensive drugs and was discharged. He was readmitted 5 days later due to hypertensive crisis and mild abdominal pain. Abdominal ultrasound with a Doppler of renal arteries showed signs right renal artery stenosis. Magnetic resonance angiography confirmed dissection of the same vessel. The patient underwent arteriography with stent implantation in the right renal artery. During outpatient follow-up, he progressed with gradual reduction of antihypertensive drugs. Conclusions:There is only 1 case report correlating renal artery dissection with cocaine use and none with concomitant presentation of dissection in the vertebral and renal arterial beds. The scarcity of reports is a consequence of many problems. Therefore, young patients presenting with new-onset hypertension or abdominal pain and cocaine abuse history should raise suspicion for renal artery dissection.

Cocaine-Induced Headache: A Review of Pathogenesis, Presentation, Diagnosis, and Management

“…In chronic cocaine users (CCUs), a headache occurs due to synaptic depletion of dopamine and serotonin causing a condition called "empty neuron", a classical migraine biochemical feature [7]. Cocaine causes vasoconstriction by activation of the sympathetic nervous system and decreases reuptake of catecholamine (noradrenaline and adrenaline), far ahead of other neurotransmitters (serotonin and dopamine), at presynaptic cleft and increases their supply at postsynaptic receptors and also releases epinephrine and norepinephrine by the adrenal medulla; moreover, it was investigated that serotonin and dopamine are also released by cocaine use [1,2,4,5]. In turn, dopamine activates alpha-1 receptors that cause powerful vasoconstriction.…”

“…There are many pathophysiological impacts caused by cocaine consumption, which include increment in oxidative stress, raised platelet activation, raised production and activation of prostaglandins, raised sympathetic activity, and endothelial dysfunction [1,2,4]. Cocaine acts the same as class I antiarrhythmic agents and local anesthetics by blocking sodium and potassium channels [2]. Arterial thrombus formation occurs in cocaine users because of increased platelet accumulation and platelet stimulation [2,5].…”

“…Cocaine acts the same as class I antiarrhythmic agents and local anesthetics by blocking sodium and potassium channels [2]. Arterial thrombus formation occurs in cocaine users because of increased platelet accumulation and platelet stimulation [2,5]. Cocaine can cause tissue ischemia by several different mechanisms, such as increasing oxygen demand of tissues, constriction of vessels, and stimulation and accumulation of platelets leading to arterial thrombi [2].…”

“…Cocaine use has increased across the world especially in teenagers and young adults, which contributes to lots of pathological conditions and adverse effects on health [1][2][3]. Brazil is one of the countries where cocaine use is very high [1].…”

“…Brazil is one of the countries where cocaine use is very high [1]. Cocaine is the second most commonly used drug in the USA and Europe after marijuana [2]. In spite of its decreased consumption in the USA and almost stable in Europe, the worldwide cocaine consumption is increased because there is increased marketing of cocaine in countries where economic conditions are not good [1].…”