Q: My friend’s husband has had a stroke at the age of 47. He has no health problems and does not smoke. The doctors said it was due to a spike in his blood pressure. Another friend told me that most strokes at this age are due to cocaine use but I would never think that he used cocaine. He has bleeding in his brain and it is at a place that they cannot operate, so they just have to wait. Do you think this could be from a drug or he just got bad genes?

A:The commonest cause for bleeding in the brain is rupture of an artery. As you know, arteries are pipes that carry blood from the heart to the brain and other parts of the body. This may be caused by a sudden surge in arterial pressure (commonly termed blood pressure) beyond the limit of tolerance of that artery or a weakness in the wall of the artery leading to the formation of a balloon (termed aneurysm). The use of cocaine, by itself, should not lead to bleeding into the brain unless the person has used infected needles and syringes and has injected germs (bacteria or fungi) into his blood stream along with the cocaine. From what you tell us, the bleeding does appear to have followed a surge in arterial pressure. The obvious conclusion is that during and after his recovery, every effort must be made to keep his arterial blood pressure within the normal range and not allow it to surge again.