The article deals with a case report on tetraplegia and acute respiratory failure following ischemic damage of the spinal medulla in the cervical tract due to cocaine assumption. The ischemic damaged produced by cocaine usually injure the great vessels of the cranial base. The case report is particular because of the area and the seize of the injured vessel. Finally, the most important hypotheses about the pathogenesis in the ischemic cerebrovascular cocaine-induced damages are debated.