Background Methamphetamine use is an emerging risk factor for intracerebral hemorrhage (ICH). The aim of this study was to investigate the use of urine drug screen (UDS) for identifying methamphetamine-associated ICH. Methods This is a retrospective, single-center study of consecutive patients hospitalized with spontaneous ICH from January 2013 to December 2017. Patients were divided into groups based on presence of UDS. The characteristics of patients with and without UDS were compared. Factors associated with getting UDS were explored using multivariable analyses. Results Five hundred ninety-six patients with ICH were included. UDS was performed in 357 (60%), and positive for methamphetamine in 44 (12.3%). In contrast, only 19 of the 357 patients (5.3%) had a documented history of methamphetamine use. Multivariable analysis demonstrated that patients screened with UDS were more likely to be younger than 45 (OR, 2.24; 95% CI, 0.26–0.78; p = 0.004), male (OR, 1.65; 95% CI, 0.44–0.84; p = 0.003), smokers (OR, 1.74; 95% CI, 1.09–2.77; p <  0.001), with history of methamphetamine use (OR, 10.48; 95% CI, 2.48–44.34; p <  0.001), without diabetes (OR 1.47; 95% CI, 0.471–0.975; p = 0.036), not on anticoagulant (OR, 2.20; 95% CI, 0.26–0.78; p = 0.004), with National Institutes of Health Stroke Scale (NIHSS) > 4 (OR, 1.92; 95%CI, 1.34–2.75; p <  0.001), or require external ventricular drain (EVD) (OR, 1.63; 95%CI, 1.07–2.47; p = 0.021. There was no significant difference in race (p = 0.319). Reported history of methamphetamine use was the strongest predictor of obtaining a UDS (OR,10.48). Five percent of patients without UDS admitted history of use. Conclusion UDS identified 12.3% of ICH patients with methamphetamine use as compared to 5.3% per documented history of drug use. There was no racial bias in ordering UDS. However, it was more often ordered in younger, male, smokers, with history of methamphetamine use, without diabetes or anticoagulant use.

Background/Objective: Methamphetamine use is associated with intracerebral hemorrhage (ICH) and is a major public health issue. The urine drug screen (UDS) is an essential test to identify and potentially control this risk factor. This study aims to analyze how an academic comprehensive stroke center uses this tool to identify methamphetamine associated ICH. Methods: Retrospective chart review of consecutive patients hospitalized with ICH from January 2013 to December 2017 was performed. Patients were divided based on presence or absence of UDS for methamphetamines. Methamphetamine associated ICH was identified per positive UDS or reported history of use. Features of patients with versus without UDS were compared using chi-square or t-test where appropriate. Results: A total of 596 consecutive patients with ICH were included in this study. UDS was performed in 357 patients (60%), and positive for methamphetamines in 44 patients (12.3%, 44/357). Among the 239 patients without UDS, 12 had self-reported history of methamphetamine abuse (5%, 12/239), resulting in a total of 56 patients with methamphetamine associated ICH (9.4%). Patients with UDS were more likely to be younger than 45 (OR=2.24; 95% CI 0.26-0.78; p=0.004), male (OR=1.65; 95% CI 0.44-0.84; p =0.003), smokers (OR=1.74; 95% CI 1.09-2.77; p<0.001), not on anticoagulant therapy (OR 2.20; 95% CI 0.26-0.78; p=0.004), with NIHSS >4 (OR=1.92; 95% CI 1.34-2.75; p<0.001), without diabetes (OR=1.47; 95% CI 0.471-0.975; p=0.036), requiring EVD (OR=1.63; 95% CI 1.07-2.47; p=0.021) or having a history of methamphetamine use (OR 10.48; 95% CI 2.48-44.34; p<0.001). There was no significant difference in race (p=0.319). Conclusion: At a comprehensive stroke center in Orange County, 9.4% of patients with ICH were methamphetamine related per UDS and history. UDS identified most of the cases (78.6%, 44/56) and was performed in only 60% of the cohort, more often in patients that were younger, male, smokers, with no anticoagulant use or history of diabetes. Methamphetamine associated ICH is common, likely underestimated, and potentially preventable. UDS may be indicated in all patients presenting with ICH and in routine health screening to reduce the risk of methamphetamine associated ICH.

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Background and Purposes: Methamphetamine use is on the rise worldwide. There are limited data and cognizance on methamphetamine-related intracerebral hemorrhage (ICH). This study aimed to investigate the characteristics of methamphetamine-related ICH and to explore the factors associated with outcomes. Methods: This retrospective cohort study enrolled consecutive ICH patients at a comprehensive stroke center between January 2011 and December 2017. Patients with methamphetamine related ICH were included for analysis of demographics, clinical features, and outcomes at hospital discharge. Factors associated with discharge outcomes were explored using multivariate logistic regression models. Results: Among the 686 consecutive patients admitted for spontaneous ICH during the study period, 412 (60.1%) had urine toxicology tests and 60 (8.7%) were identified to have methamphetamine use per history and positive urine test. Of note, 30 patients who denied substance use had positive urine test. The mean age was 51.8 years old and 78.3% patients were male. There was significant racial disparity in methamphetamine use, with highest ratio in Hispanics (14.9%), followed by White (9.2%), African Americans (5.7%), and Asians (1.2%). The mortality rate of methamphetamine-related ICH was 18.3% and only 25.0% patients achieved functional independence at hospital discharge. NIHSS (OR=0.15; 95% CI 0.04-0.62; P=0.005), GCS (OR=0.05; 95% CI 0.01-0.43; P=0.001), ICH score (OR=0.08; 95% CI 0.01-0.67; P=0.005), smoking history (OR=6.76; 95% CI 1.82-25.00; P=0.002), surgical intervention (OR=0.13; 95% CI 0.03-0.66; P=0.007) and ventilator support (OR=0.11; 95% CI 0.02-0.56; P=0.003) were independently associated with functional status. Risk factors of mortality include NIHSS (OR=2.45; 95% CI 1.75-3.44; P<0.001), GCS (OR=3.06; 95% CI 2.05-4.59; P<0.001), ICH score (OR=4.46; 95% CI 2.65-7.52; P<0.001), creatinine level (OR=8.97; 95% CI 2.12-37.98; P=0.001) and ventilator support (OR=2.89; 95% CI 1.96-4.24; P<0.001). Conclusion: Methamphetamine use is a major cause of ICH, especially in Hispanic population. Clinical severity scores, elevated creatinine levels, and ventilator support are associated with poor outcomes at hospital discharge.

outcomes in a center that receives patients from rural and underserved areas. We retrospectively reviewed the electronic medical record of 38 patients admitted to Sanford Health Cerebrovascular Service in Fargo, ND between March 2015 and May 2017 who underwent endovascular intervention for acute ischemic stroke secondary to a small caliber vessel occlusion. An average change in National Institutes of Health Stroke Scale (NIHSS) score of 4.94 was observed after intervention with mechanical thrombectomy with 26.31% of patients having a decrease in NIHSS of 10 or more and 36.84% of patients having a reduction of 6 or more. Successful recanalization was achieved in 94.74% of cases. Given the high rates of revascularization and significant reductions in NIHSS scores, mechanical thrombectomy may be reasonably extended to patients with occlusion of smaller, more distal vessels.