Cannabis Use, Ischemic Stroke, and Multifocal Intracranial Vasoconstriction

Abstract

Background and Purpose-Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population. Methods-Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months. Results-In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (nϭ10). Conclusions-Multifocal MethodsFrom October 2005 to September 2007, 48 consecutive patients younger than 45 years of age who were admitted to our stroke unit for IS were included in this study. Patients were informed that they were included in a prospective study and agreed to participate. Standard T1, T2, FLAIR sequences, diffusion weighted-imaging magnetic resonance imaging scans were acquired for all patients. Vascular imaging comprised 3D-time of flight magnetic resonance angiography (nϭ43) or cerebral computed tomography angiography (nϭ5). Cardiac explorations included electrocardiogram (nϭ48), transthoracic echocardiography (nϭ48), and transoesophageal echocardiography (nϭ29). Exhaustive laboratory analyses were performed for all patients. If first-line investigations were inconclusive, 3D rotational angiography (nϭ30) and cerebrospinal fluid analysis (nϭ29) were performed. A questionnaire was used to determine cardiovascular risk factors, history of medication, and illicit drug or alcohol use. Urines were systematically screened for cannabinoids, cocaine, amphetamine, and methylenedioxymethamphetamine. Follow-up clinical visits (nϭ44) and control of vascular imaging (nϭ20) were planned within 3 to 6 months after discharge from hospital.One study neurologist and 1 study radiologist separately reviewed all 3D-time of flight or computed tomography angiography images. A single operator performed all 3D rotational angiography, and 2 study radiologists, who were unaware of magnetic resonance angiography results, reviewed the 3D rotational angiography images. Involvement of single or several vessel segments were respectively classified as monoarterial stenosis or as multifocal intracranial stenosis (MIS). Statistical AnalysisData are summarized using descriptive statistics. Because of sparseness of data, computations of odds ratio and 95% CI, as well as multivariate logistic regression, were obtained using exact methods (StatXact and LogXact). The logistic regression was designed using the group of MIS as the dependent variable and the other variables as potential predictors. A probability value Յ5% was considered statistically significant. ResultsTable displays the relationship between stroke etiology, classical risk factors, and cannabis use in the 48 patients. There were no patients undergoing serotonergic medical treatment, and there were no amphetamine, meth...

Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

“…The attenuated decreases in DV with MP in the marijuana abusers were observed throughout the brain but were most accentuated in cerebellum. The higher sensitivity of the cerebellum to what we interpret to reflect changes in vascular reactivity with marijuana abuse is consistent with clinical findings that report strokes associated with marijuana abuse are more frequently localized in the posterior circulation and ischemia is most frequently observed in cerebellum (25,(54)(55)(56). Cerebellar arteries express CB1 receptors in the smooth muscle layer (57), but because comparisons with arteries in other brain regions have not been done, it is not possible to determine if higher levels of CB1 receptors in cerebellar arteries underlie their higher sensitivity to vascular effects from marijuana.…”

The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update

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“…12 Since the legalization of medical marijuana in Colorado, a number of reports of children with toxic ingestions have occurred. 10 Treatment with activated charcoal to prevent absorption of the marijuana may be helpful in specific severe situations if there is no concern about level of consciousness and if treatment is initiated well within 2 hours of onset of the ingestion. As with any other prescribed medication for adults, children should not have access to medical marijuana, with the exception of unique circumstances discussed later.…”

1301 – Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings

“…Of the 142 studies identified, thirty-six did not meet the a priori selection criteria [33, and sixty-two met the exclusion criteria [6,12,30,48, or were case/series reports [142] (for more detailed information, see Figure 1). The remaining 43 studies were classified according to the neuroimaging technique used (structural/functional), age of the participants [adolescents (# 18 years) and adults (.…”