Stroke after heavy marijuana smoking.

Abstract

I examined two young men who developed cerebral infarction associated with heavy marijuana smoking. Both were light tobacco smokers, but they did not drink alcohol or use other street drugs. Diagnostic work-up for nonatherosclerotic causes of stroke was unremarkable. I postulate that marijuana-associated alterations in systemic blood pressure resulted in vasospasm, leading to strokes in these patients. (Stroke 1991;22:406-409) S troke associated with drug abuse has been reported frequently. 1 Although the incidence and prevalence of cerebral infarction and intracranial hemorrhage associated with drug abuse is uncertain, case series have provided extensive documentation of stroke occurring with the use of street drugs, especially cocaine, amphetamines, "Ts and blues," anabolic steroids, lysergic acid diethylamide, barbiturates, alcohol, and heroin.2 -8 However, an acute neurological deficit following heavy marijuana smoking has been reported infrequently. 13 I examined two young men who had cerebral infarction during heavy marijuana smoking. Case Reports Case 1A previously healthy 34-year-old right-handed white man experienced the sudden onset of dizziness, left arm and leg weakness, and slurred speech while smoking a marijuana cigarette. There was no headache, and he denied the use of other street drugs and alcohol. He had smoked less than one pack of tobacco cigarettes and up to seven marijuana cigarettes per day for 15 years. Recently, he had increased his marijuana smoking from seven to a 14 cigarettes per day. There was no family history of stroke, heart disease, hypertension, diabetes mellitus, migraine headache, lupus erythematosus, autoimmune disorders, or sickle cell disease. This patient's blood pressure was 164/110 mm Hg and his pulse was 104 beats/min on admission. Neurological examination performed <,2 hours after the onset of symptoms showed severe dysarthria, rightleft disorientation, and acalculia. Cranial nerve exam- Received July 20, 1990; accepted November 20, 1990. ination revealed left lower facial weakness. Strength of the left leg was 0/5, strength of the left arm was 1/5, and there was loss of pinprick and temperature sensation on the left side. Results of the following laboratory studies were within normal ranges: complete blood count; platelet count; fibrinogen level; prothrombin time; partial thromboplastin time; concentrations of serum glucose, electrolytes, cholesterol, high density lipoprotein, low density lipoprotein, and triglycerides; liver and renal function tests; concentrations of metanephrine and catecholamines; erythrocyte sedimentation rate; presence of antinuclear antibodies and rheumatoid factor; VDRL; concentrations of C3 and C4; platelet function tests; lupus anticoagulant, anticardiolipin antibody, and protein C; human immunodeficiency virus titer; and concentration of antithrombin-3. The results of 24-hour Holter monitoring and echocardiography were normal. The results of renal angiography, done because of the patient's hypertension, were also normal. He did not con...

Cannabis-related Stroke

“…16,21,28,38 Furthermore, in other cases, strokes have occurred up to half an hour after the last joint has been smoked. 12,16,20,25,27 These results are in accordance with one large study showing that cannabis increases myocardial infarction 4.8-fold during the hour following its intake. 44 In a review …”

“…In the literature, 59 case reports of cannabis-related stroke (mean age, 33±12.4 years) were described, and among them there was a majority of men with a sex ratio of 4.9:1. Most of stroke were IS (n=49) 11,12,[14][15][16][17][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] or transient ischemic attacks (n=5). 14,38,39 There is only 1 patient who was described with an hemorrhagic stroke associated with cannabis use.…”

“…The following cardiovascular effects of cannabis may be involved in proposed mechanisms of stroke relating to cannabis use: orthostatic hypotension with secondary impairment of the autoregulation of cerebral blood flow, altered cerebral vasomotor function, supine hypertension and swings in blood pressure, cardioembolism with atrial fibrillation, or other arythmias, 1,20,27,33,[45][46][47] vasculopathy (toxic or with immune inflammatory), vasospasm, 21 reversible cerebral vasoconstriction syndrome (RCVS), 3,20 or multifocal intracranial stenosis (MIS). 17 Zacchariah 20 proposed that in patients with IS, elevation of blood pressure could be a reaction to cerebral vasospasm preceded by hypotension.…”

Safety Issues Concerning the Medical Use of Cannabis and Cannabinoids

“…Transient ischemic attacks (51) and cerebrovascular stroke, usually following acute cannabis use, have also been reported in several case reports (52)(53)(54)(55)(56). Renal infarction following cannabis smoking has also been reported (57).…”

EEG of chronic marijuana users during abstinence: Relationship to years of marijuana use, cerebral blood flow and thyroid function

“…Most problematic among young marijuana users is the view that marijuana was not harmful (Gruber & Pope, 2002;Hall & Degenhardt, 2006) even though cognitive and psychiatric impairments have been documented in heavy marijuana users (Fletcher et al, 1996;Pope et al, 1996Pope et al, , 2001Ehrenreich et al, 1999;Bolla et al, 2002;Solowij et al, 2002;Fergussion et al, 2006). Strokes in relatively young individuals have also been reported (Cooles & Michaud, 1987;Zarchariah, 1991;Barnes et al, 1992;Lawson & Rees, 1996;MacCarron, 1997;White et al, 2000;Marinella, 2001;Mesec et al, 2001;Alvaro et al, 2002). Related to the cognitive impairments and strokes, altered cerebral blood flow has also been observed in chronic marijuana users during abstinence (Tunving et al, 1986;Amen, & Waugh, 1998;Lundqvist et al, 2001;Block et al, 2002;Herning et al, 2005;Sneider et al, 2006).…”