Cerebral angiitis and intracerebral hemorrhage associated with methamphetamine abuse

Yu, Young J.; Cooper, David R.; Wellenstein, David E.; Block, Brian M.

doi:10.3171/jns.1983.58.1.0109

Cited by 60 publications

(20 citation statements)

References 6 publications

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“…2) The mechanisms of action of amphetamines as a cause of ICH may involve acute arterial inflammation (arteritis) and a sharp rise in blood pressure due to the sympathomimetic effect. 4,6,7,10) Most cases of ICH have occurred in patients with a known clinical history of amphetamine abuse. 4,6,7,10) The onset of ICH is usually acute, i.e., within several hours after the use of amphetamines, and the frequency of drug abuse increases the risk of the hemorrhage, although some patients sustained ICH after their initial use of amphetamines.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,7,10) Most cases of ICH have occurred in patients with a known clinical history of amphetamine abuse. 4,6,7,10) The onset of ICH is usually acute, i.e., within several hours after the use of amphetamines, and the frequency of drug abuse increases the risk of the hemorrhage, although some patients sustained ICH after their initial use of amphetamines. 4,6,7,10) To raise the suspicion of illegal drugs as causative agents in young, previously healthy patients presenting with progressive neurological deficits is often difficult, especially if no family members or witnesses are available to report the possible use of such drugs.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,7,10) The onset of ICH is usually acute, i.e., within several hours after the use of amphetamines, and the frequency of drug abuse increases the risk of the hemorrhage, although some patients sustained ICH after their initial use of amphetamines. 4,6,7,10) To raise the suspicion of illegal drugs as causative agents in young, previously healthy patients presenting with progressive neurological deficits is often difficult, especially if no family members or witnesses are available to report the possible use of such drugs. Laboratory testing to search for psychotropic drugs in young, non-hypertensive patients with ICH may not be a common neurosurgical practice, even after angiographic evaluation yielded negative findings.…”

Section: Discussionmentioning

confidence: 99%

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Subcortical Hemorrhage Caused by Methamphetamine Abuse: Efficacy of the Triage System in the Differential Diagnosis. Case Report.

Inamasu

Nakamura

Saito

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 32-year-old woman was brought to the emergency room with hemiplegia on the left and consciousness disturbance. Her prior medical history and the circumstances of the onset were unknown. Brain computed tomography showed intracerebral hemorrhage (ICH) with a midline shift of more than 10 mm in the right parietal lobe. Cerebral angiography failed to show any vascular anomalies. Urine analysis with the triage system, a qualitative screening test for psychotropic drug abuse, showed positive reaction for amphetamines. Subsequent laboratory examination confirmed a highly elevated serum concentration of methamphetamine. The patient underwent evacuation of the hemorrhage via a craniotomy, and was discharged 40 days after admission. Abuse of illegal drugs including amphetamines among young adults is increasing in many developed countries, and the suspicion of possible drug abuse should always be raised in young patients with angiographically negative ICH. A urinalysis screening test for psychotropic agents should be a part of routine emergency room diagnostic procedures for such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Subcortical Hemorrhage Caused by Methamphetamine Abuse: Efficacy of the Triage System in the Differential Diagnosis. Case Report.

Inamasu

Nakamura

Saito

et al. 2003

Neurol. Med. Chir.(Tokyo)

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“…This patient also did not show any central nervous system findings or fluoroscein angiographic evidence of necrotizing angiitis related to vascular occlusion. 4 Her acute unilateral visual loss is a result of ischaemia to the posterior ciliary arteries of the left eye from vasoconstriction secondary to phentermine.…”

Section: Commentmentioning

confidence: 99%

Acute nonarteritic ischaemic optic neuropathy after phentermine

Chan

2004

Eye

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Sir, Acute nonarteritic ischaemic optic neuropathy after phentermineAmphetamine derivatives used in weight reduction regimens are considered safe for use over a several week period. Ischaemic and/or haemorrhagic infarcts and necrotizing angiitis are common neurologic complications of amphetamine abuse. Ocular side effects of amphetamine abuse include mydriasis, decreased accommodation and convergence, visual hallucinations (blue tinge to objects), retinal vasoconstriction and vasculitis, retinal microaneurysms and haemorrhage, and anterior ischaemic optic neuropathy. 1 In this report a 35-year-old woman developed acute nonarteritic anterior ischaemic optic neuropathy (NAION) after two prescribed dosages of phentermine hydrochloride as part of her weight loss treatment. Case reportThis obese 35-year-old Caucasian woman developed an acute superior nasal visual field defect in her left eye 1 day after taking Adipex-P (phentermine hydrochloride) 37.5 mg p.o.q. day for 2 days. Her body mass index was 34 kg/m 2 . She had no history of heart disease, diabetes, hypertension, hypercholesterolaemia, or strokes.On neuro-ophthalmologic examination her visual acuity with correction was 20/20 OD and 20/100 OS. Humphrey visual fields revealed a left superior nasal focal defect respecting the horizontal meridian. She had a left relative afferent pupillary defect and a protan defect. Extraocular motility was normal. Slit-lamp examination revealed no cells or flare in the anterior chambers. On dilated funduscopic examination, her left optic disc appeared swollen with small slit-like peripapillary haemorrhages in the superior and temporal aspect of the disc. A small petechial haemorrhage was seen at the 5 o'clock position in the peripapillary region. No cotton wool spots were observed. Her right cup-to-disc ratio was 0.3. Maculae and peripheral retina were normal.MRI of the brain and orbits with gadolinium, MRA of the cerebral blood vessels, carotid ultrasound, and transoesophageal echocardiogram were all normal. Her cerebrospinal fluid (CSF) opening pressure was 148 mm H 2 O; CSF cell count, protein, glucose, VDRL, gram stain, bacterial, viral, and fungal cultures were all unremarkable. Leber's hereditary optic neuropathy mitochondrial DNA mutations for 3460, 11778, 14484, and 15257 alleles were all negative. Autoimmune profile including antinuclear antibody, double stranded DNA,

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“…1,2 In particular, several previous reports stated that methamphetamine abuse increased the risk of cerebral vascular accidents such as hemorrhagic or ischemic stroke, and subarachnoid hemorrhage even in young persons aged less than 20 years. [3][4][5][6][7] In this report, we describe a fatal case of pontine hemorrhage, presumably due to intravenous self-administration of methamphetamine.…”

Section: Introductionmentioning

confidence: 99%