Article Access Statistics | | Viewed | 3915 | | Printed | 170 | | Emailed | 1 | | PDF Downloaded | 216 | | Comments | [Add] | | Cited by others | 12 | |
|

 Click on image for details.
|
|
LETTER TO EDITOR |
|
|
|
Year : 2009 | Volume
: 57
| Issue : 1 | Page : 91-92 |
Posterior circulation stroke in a cannabis abuser
Simerpreet Bal, Dheeraj Khurana, Vivek Lal, Sudesh Prabhakar
Department of Neurology, Postgraduate Institute of Medical Education of Research, Sector 12, Chandigarh - 160 012, India
Date of Acceptance | 08-Feb-2009 |
Correspondence Address: Dheeraj Khurana Department of Neurology, Postgraduate Institute of Medical Education of Research, Sector 12, Chandigarh - 160 012 India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.48797
How to cite this article: Bal S, Khurana D, Lal V, Prabhakar S. Posterior circulation stroke in a cannabis abuser. Neurol India 2009;57:91-2 |
Sir,
Drug abuse is a risk factor for stroke in the young. We describe a case of a cannabis abuser presenting with a posterior circulation stroke. A 22-year-old right-handed male, with history of cannabis abuse for the last two years presented with sudden limb and gait ataxia, 5h after consuming seven cigarettes of cannabis. Neurological examination revealed normal higher mental functions except for inappropriate laughter. He had bilateral cerebellar signs, Deep tendon reflexes were brisk and plantar was extensor bilaterally. Cranial magnetic resonance imaging (MRI) showed infarcts in bilateral cerebellar hemispheres, left temporal lobe and an old infarct in the left occipital lobe [Figure 1]. Magnetic resonance angiography (MRA) revealed non-visualization of left vertebral artery and reduced caliber of both the posterior cerebral arteries [Figure 2]. Biochemistry was normal and procoagulant workup and also the workup for young stroke were negative. 2D echo was normal. Patient was put on antiplatelets and at three months follow-up his modified Rankin scale score was 2D echo.
Cocaine, cannabis, amphetamines and marijuana are the common recreational drugs associated with ischemic and hemorrhagic strokes. The side-effects of acute cannabis intoxication include: (1) psychiatric - behavioral abnormalities and increased risk of schizophrenia; [1] (2) cardiovascular - tachycardia, supine hypertension, postural hypotension, myocardial infarction, paroxysmal atrial fibrillation and sudden death; [2] (3) cerebral - hemorrhagic and recurrent ischemic strokes. The mechanisms postulated in cannabis-related strokes are vasospasm, vasculopathy, postural hypotension with abnormal regulation of the cerebral blood flow and paroxysmal atrial fibrillation. [3] A predilection for infarcts in the posterior circulation as seen in our patient has been attributed to a poor autoregulatory mechanism in this vascular bed as compared to the anterior circulation. [4] Toxicological screening for cannabinoid metabolites should be done in young patients with strokes with no apparent vascular risk factors or evidence of dissection. This holds good even in our country with increasing drug abuse among the youth.
» References | |  |
1. | Andrιasson S, Allebeck P, Engstrφm A, Rydberg U. Cannabis and schizophrenia: A longitudinal study of Swedish conscripts. Lancet 1987;2:1483-6. |
2. | Bachs l, Morland H. Acute cardiovascular fatalities following cannabis use. Forensic Sci Int 2001;124:200-3. |
3. | Cooles P, Michaud R. Stroke after heavy cannabis smoking. Postgrad Med J 1987;63:511. |
4. | Mateo I, Pinedo A, Gomez-Beldarrain M, Basterretxea JM, Garcia-Monco JC. Recurrent stroke associated with cannabis use. J Neurol Neurosurg Psychiatry 2005;76:435-7. |
[Figure 1], [Figure 2]
This article has been cited by | 1 |
Ictus y consumo de cannabis en pacientes sin factores de riesgo cardiovascular: revisión sistemática de casos clínicos |
|
| S.A. Gómez Ochoa | | Neurología. 2017; | | [Pubmed] | [DOI] | | 2 |
Strokes are possible complications of cannabinoids use |
|
| Valérie Wolff,Emilie Jouanjus | | Epilepsy & Behavior. 2017; 70: 355 | | [Pubmed] | [DOI] | | 3 |
Angiopatie cerebrali tossiche |
|
| V. Wolff | | EMC - Neurologia. 2016; 16(1): 1 | | [Pubmed] | [DOI] | | 4 |
Complications vasculaires périphériques, cardiaques et cérébrales associées à l’utilisation du cannabis |
|
| Emilie Bouccin,Hélène Eloye,Philippe Hantson | | Toxicologie Analytique et Clinique. 2016; 28(2): 115 | | [Pubmed] | [DOI] | | 5 |
Cannabis and Stroke |
|
| Daniel G. Hackam | | Stroke. 2015; 46(3): 852 | | [Pubmed] | [DOI] | | 6 |
Cannabis-related Stroke |
|
| Valérie Wolff, Jean-Paul Armspach, Valérie Lauer, Olivier Rouyer, Marc Bataillard, Christian Marescaux, Bernard Geny | | Stroke. 2013; 44(2): 558 | | [Pubmed] | [DOI] | | 7 |
Cannabis-related stroke: Myth or reality? |
|
| Wolff, V. and Armspach, J.-P. and Lauer, V. and Rouyer, O. and Bataillard, M. and Marescaux, C. and Geny, B. | | Stroke. 2013; 44(2): 558-563 | | [Pubmed] | | 8 |
Cannabis-Associated Arterial Disease |
|
| Anne Claire Desbois,Patrice Cacoub | | Annals of Vascular Surgery. 2013; 27(7): 996 | | [Pubmed] | [DOI] | | 9 |
Cannabis-Related Stroke: Case Series and Review of Literature |
|
| Niranjan N. Singh,Yi Pan,Sombat Muengtaweeponsa,Thomas J. Geller,Salvador Cruz-Flores | | Journal of Stroke and Cerebrovascular Diseases. 2012; 21(7): 555 | | [Pubmed] | [DOI] | | 10 |
Cannabis-related stroke: Case series and review of literature |
|
| Singh, N.N. and Pan, Y. and Muengtaweeponsa, S. and Geller, T.J. and Cruz-Flores, S. | | Journal of Stroke and Cerebrovascular Diseases. 2012; 21(7): 555-560 | | [Pubmed] | | 11 |
Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction: A prospective study in 48 consecutive young patients |
|
| Wolff, V., Lauer, V., Rouyer, O., Sellal, F., Meyer, N., Raul, J.S., Sabourdy, C., (...), Marescaux, C. | | Stroke. 2011; 42(6): 1778-1780 | | [Pubmed] | | 12 |
Cannabis Use, Ischemic Stroke, and Multifocal Intracranial Vasoconstriction |
|
| Valérie Wolff, Valérie Lauer, Olivier Rouyer, François Sellal, Nicolas Meyer, Jean Sébastien Raul, Cécile Sabourdy, Fazel Boujan, Christine Jahn, Rémy Beaujeux, Christian Marescaux | | Stroke. 2011; 42(6): 1778 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
|