Subarachnoid Hemorrhage from a Thoracic Radicular Artery Pseudoaneurysm after Methamphetamine and Synthetic Cannabinoid Abuse: Case Report

Abstract

Background Context Isolated spinal artery aneurysms not associated with vascular malformations are exceedingly rare. Purpose To present a rare case of subarachnoid hemorrhage after thoracic radiculomedullary artery pseudoaneurysm rupture in a patient who abused synthetic cannabinoids and methamphetamines. Study Design Case report. Methods A 41-year-old man with a history of polysubstance abuse presented with acute-onset headache, back pain, and transient bilateral lower-extremity numbness. He reported daily use of the synthetic cannabinoid “Spice.” He denied use of other illegal drugs, but laboratory testing was positive for methamphetamines. Magnetic resonance imaging showed a focal hematoma at T2–3, and spinal angiography was negative for vascular abnormalities; however, a follow-up angiogram 6 days later revealed interval development of an irregular dilation of the left T3 radiculomedullary artery originating from the left supreme intercostal artery. Results Surgical trapping and resection of the lesion yielded a good clinical outcome. Conclusions Although two previous case reports have described patients with thoracic radiculomedullary pseudoaneurysm causing spinal subarachnoid hemorrhage (SAH), this is the first reported case associated with synthetic cannabinoids and methamphetamine abuse. Although this diagnosis is exceptionally rare, clinical presentation of SAH with associated back pain and lower-extremity symptoms warrants an aggressive imaging workup. Even in the setting of negative angiography, repeat cerebral and spinal angiograms may be necessary to identify a potentially treatable cause of spinal SAH.

Hemorrhagic stroke following use of the synthetic marijuana “spice”

“…Methamphetamine use and an irregular, dilated radiculomedullary artery confounded one report of spice-associated spinal SAH. 10 Our patients had no further illicit drug use found on history or screening, vascular malformations, or other apparent risk factors. Physicians, nurses, emergency medical technicians, hospitals, public health officials, educators, and law enforcement see dangers of inhaled synthetic compounds firsthand.…”

What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review

“…The mean age was 31 years (95%CI = 29-34). There were five cases of thromboangiitis obliterans [16,28,33,50,82], four hemorrhagic strokes [36,37,72,73], and two episodes of myopericarditis [55,85]. Heart rate and blood pressure for both genders were provided in 40 and 43 cases, respectively.…”

Intraoperative Ultrasound of the Spine

“…Cocaine and methamphetamine abuse are well known risk factors for intracranial subarachnoid hemorrhage and there are recent case reports of spinal SAH secondary to methamphetamine abuse. 28,29 …”