Recurrent stroke associated with cannabis use

Service of Neurology, Hospital de Galdacano, 48960 Galdacano, Vizcaya, Spain.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 04/2005; 76(3):435-7. DOI: 10.1136/jnnp.2004.042382
Source: PubMed


Drug misuse represents a risk factor for cerebrovascular disease, especially among young people. Despite the fact that cannabis is the most widely used illicit drug, there are only a few reports associating its use with cerebrovascular disease. We describe a patient who suffered three ischaemic strokes immediately after cannabis consumption. Other stroke aetiologies were ruled out, and neuroimaging revealed infarcts in different arterial areas as well as evidence of non-atherosclerotic arterial disease, which suggests an underlying vasculopathy of uncertain (toxic or inflammatory) origin. Cannabis use may be associated with ischaemic stroke in young patients, but its mechanism is unclear.

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Available from: Juan Carlos García-Moncó, Dec 25, 2013
    • "Patients in which arteritis were found are regular users of cannabis and tobacco smokers.[411] Mateo et al.[4] described a mild decrease in the distal branches of the left MCA on MRA in a patient with recurrent stroke after cannabis abuse and suggested that the most likely mechanism was a vasculopathy, either toxic or immune inflammatory, elicited by cannabis. It is plausible that this might be the mechanisms for stroke in this illustrated case. "
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    ABSTRACT: Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies.
    10/2014; 5(4):417-9. DOI:10.4103/0976-3147.140008
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    • "The encouraging therapeutic results of this study are in partial contrast with previous case reports, suggesting a potential relationship between stroke and chronic cannabis abuse in young human beings [117–120]. Importantly, Mateo and coworkers recently confirmed the potential association between cannabis and ischemic stroke recurrence in a young patient, without identifying the underlying pathophysiological mechanisms [121]. Evidence from autopsy examinations and imaging reports in both human beings and animal models has suggested that cannabis use might provoke cerebral stroke by favouring the development of atrial fibrillation, orthostatic hypotension, and cerebral artery vasospasm [122–124]. "
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    ABSTRACT: Cannabinoids are considered as key mediators in the pathophysiology of inflammatory diseases, including atherosclerosis. In particular, they have been shown to reduce the ischemic injury after acute cardiovascular events, such as acute myocardial infarction and ischemic stroke. These protective and anti-inflammatory properties on peripheral tissues and circulating inflammatory have been demonstrated to involve their binding with both selective cannabinoid type 1 (CB₁ and type 2 (CB₂) transmembrane receptors. On the other hands, the recent discoveries of novel different classes of cannabinoids and receptors have increased the complexity of this system in atherosclerosis. Although only preliminary data have been reported on the activities of novel cannabinoid receptors, several studies have already investigated the role of CB₁ and CB₂ receptors in ischemic stroke. While CB₁ receptor activation has been shown to directly reduce atherosclerotic plaque inflammation, controversial data have been shown on neurotransmission and neuroprotection after stroke. Given its potent anti-inflammatory activities on circulating leukocytes, the CB₂ activation has been proven to produce protective effects against acute poststroke inflammation. In this paper, we will update evidence on different cannabinoid-triggered avenues to reduce inflammation and neuronal injury in acute ischemic stroke.
    Mediators of Inflammation 04/2012; 2012(4):824093. DOI:10.1155/2012/824093 · 3.24 Impact Factor
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    • "even when controlling for other risk factors (Kaku and Lowenstein 1990). Twenty-one cases of imaging-positive stroke related to marijuana use have been reported (Cooles and Michaud 1987; Zachariah 1991; Barnes et al. 1992; Lawson and Rees 1996; McCarron and Thomas 1997; Mouzak et al. 2000; Mesec et al. 2001; Mathew et al. 2003; Finsterer et al. 2004; Geller et al. 2004; Moussouttas 2004; Mateo et al. 2005; Aryana and Williams 2007; Duchene et al. 2010; Renard et al. 2010). Twenty were ischemic infarcts in men; one was an ischemic infarct in a woman (Duchene et al. 2010). "
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    ABSTRACT: Drug abuse robs individuals of their jobs, their families, and their free will as they succumb to addiction; but may cost even more: a life of disability or even life lost due to stroke. Many illicit drugs have been linked to major cardiovascular events and other comorbidities, including cocaine, amphetamines, ecstasy, heroin, phencyclidine, lysergic acid diethylamide, and marijuana. This review focuses on available epidemiological data, mechanisms of action, particularly those leading to cerebrovascular events, and it is based on papers published in English in PubMed during 1950 through February 2011. Each drug's unique interactions with the brain and vasculature predispose even young, healthy people to ischemic or hemorrhagic stroke. Cocaine and amphetamines have the strongest association with stroke. However, the level of evidence firmly linking other drugs to stroke pathogenesis is weak. Large epidemiological studies and systematic evaluation of each drug's action on the brain and cardiovascular system are needed to reveal the full impact of drug use on the population.
    Brain and Behavior 09/2011; 1(1):44-54. DOI:10.1002/brb3.7 · 2.24 Impact Factor
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