DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.039

Pages: 2589-2593

Spontaneous intracerebral hemorrhage in a relatively young adult warrants a search for an underlying vascular or structural cause, even when exposure to a sympathomimetic drug is documented. We report the case of a 42-year-old woman with depression, reported polysubstance use and chronic tobacco smoking, who was found at home with impaired consciousness after approximately two days without being seen. On admission, her Glasgow Coma Scale score was 11/15, with aphasia and right-sided hemiparesis. Urine screening was positive for cocaine and morphine, with trace benzodiazepines and tricyclic antidepressants. Non-contrast computed tomography showed a left temporo-insulo-parietal intraparenchymal hematoma with perilesional edema and local mass effect, and computed tomography angiography showed no macrovascular lesion. After neurosurgical evaluation, she was managed conservatively; follow-up imaging showed no hematoma expansion, and her neurological status improved gradually until discharge with a rehabilitation plan. Through this case and a focused review of the literature, we emphasize that a positive cocaine screen should not be equated with a proven hemorrhagic mechanism. In younger patients, appropriate vascular imaging, cautious interpretation of drug screening and guideline-based neurocritical care remain essential.