Following her admission to hospital, the woman received five days of drug therapy with propranolol, phenytoin, and phenobarbital until she died. The autopsy revealed a distinctive cerebral vasculitis with features characteristic of hypersensitivity drug included vasculitis. The distinct vasculitis observed in this victim corresponds with the known morphologic patterns of drug reactions, especially of the nonnectrotizing, hypersensitivity type. While the distribution in leptomeningeal and small cortical vessels is strikingly similar to other cases reported in the literature, large vessel lesions described elsewhere were not observed. The autopsy results suggest that cocaine associated vasculitis is of the small vessel, hypersensitivity type. The role that such a vasculitis may play in the development of cocaine-associated strokes has not been determined. 2 figures and 26 references