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Simultaneous multifocal intracranial haemorrhage (ICH) and subarachnoid haemorrhage (SAH) in the setting of long-term cocaine usage
  1. Minnan Al-Khafaji1,
  2. Sabina Podbicanin1,
  3. Deep Ghaghda1,
  4. Saajan Basi2,3 and
  5. Shuja Punekar4
  1. 1School of Medicine, University of Nottingham, Nottingham, UK
  2. 2General Internal Medicine, Royal Derby Hospital, Derby, UK
  3. 3Acute Stroke Department, King's Mill Hospital, Sutton-in-Ashfield, UK
  4. 4Sherwood Forest Hospitals NHS Trust, Nottinghamshire, UK
  1. Correspondence to Dr Saajan Basi; saajan.basi{at}


A 45-year-old Caucasian man was admitted to hospital following a collapse at home. On admission, this patient was noted to have a Glasgow Coma Scale (GCS) Score of 9 out of 15, fever and tachypnoea. The patient was identified to have bilateral limb weakness, predominately on the left side, with associated dysphagia. Radiological imaging demonstrated bilateral multifocal intracranial haemorrhage and subarachnoid haemorrhage. Neurosurgical input was sought; the outcome of this was a decision to manage the patient conservatively, without surgical intervention. Of note, his urine drug testing revealed a positive result for a cocktail of drugs including cocaine, benzoylecgonine (cocaine metabolite), methadone, heroin, norbuprenorphine and benzodiazepine. Throughout the admission, the patient was monitored in an intensive care setting. The patient received support with feeding, speech and mobilisation. The patients’ GCS improved throughout the admission. Following a 30-day admission, the patient walked home.

  • toxicology
  • stroke
  • trauma CNS /PNS
  • vasculitis

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  • Contributors MA-K, DG and SP were involved in the collecting of information for the case, the initial written draft of the case and researching existing data on acute stroke and COVID-19. SB and SP alongside MA-K and DG edited drafts of the report. SB and SP were involved in reviewing and editing drafts of the report and contributing new data. SB and SP oversaw the conduction of the project and contributed additional research papers. SB was in charge of responding to reviewers feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.