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Cerebrovascular Complications of Methamphetamine Abuse

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Abstract

Objective

Methamphetamine is a stimulant widely abused in the United States. The objective of this study was to demonstrate an association of methamphetamine use and ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage and to further reveal the underlying vascular pathology using neuroimaging and pathology.

Methods

This was a retrospective study based on medical chart review of admissions to the neurovascular service of a tertiary care medical center from January 2003 to July 2007. Cases included patients who used methamphetamine as documented by history or urine toxicology screening.

Results

From 1,574 records, 30 cases were identified. The mean age of patients was 43 years and the discharge diagnoses included ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. All subarachnoid hemorrhages were aneurysmal with the majority of the aneurysms located in the anterior circulation. The majority of strokes were located in the anterior circulation. In many cases, radiologic imaging confirmed arterial stenoses in the vascular distribution of the stroke. One patient who presented with ischemic stroke had severe atherosclerosis of bilateral common, internal, and external carotid arteries. On pathology, there was no evidence of inflammation or necrosis to suggest vasculitis as a possible etiology.

Conclusions

Methamphetamine use is associated with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, especially among young patients. We showed no evidence that the ischemic stroke associated with methamphetamine use is due to an inflammatory etiology but may be due to a process of accelerated atherosclerosis.

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Abbreviations

ACA:

Anterior cerebral artery

AM:

Amphetamine

AVM:

Arteriovenous malformation

CCA:

Common carotid artery

CO:

Cocaine

CTA:

CT angiogram

DM:

Diabetes mellitus

Dx:

Diagnosis

EtOH:

Ethanol

F:

Female

HA:

Headache

HE:

Heroin

HH:

Homonymous hemianopsia

HP:

Hemiparesis

HPL:

Hemiplegia

HTN:

Hypertension

ICA:

Internal carotid artery

ICH:

Intracerebral hemorrhage

IS:

Ischemic stroke

L:

Left

M:

Male

MA:

Methamphetamine

MCA:

Middle cerebral artery

MJ:

Marijuana

MRA:

MR angiogram

ND:

Not determined

PCA:

Posterior cerebral artery

PICA:

Posterior inferior cerebellar artery

Prox:

Proximal

R:

Right

SAH:

Subarachnoid hemorrhage

SDH:

Subdural hemorrhage

SQH:

Superior quadrant hemianopsia

STD:

Standard deviation

SZ:

Seizure

TIA:

Transient ischemic attack

UE:

Upper extremity

Utox:

Urine toxicity

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Author information

Authors and Affiliations

  1. Department of Neurology, University of California San Francisco, 1001 Potrero Ave., SFGH 4M62, Box 0870, San Francisco, CA, 94143-0870, USA

    Emily L. Ho

  2. Department of Neurology, University of California San Francisco, 505 Parnassus Ave., Box 0114, San Francisco, CA, 94143-0114, USA

    S. Andrew Josephson & Wade S. Smith

  3. Department of Pathology, University of California San Francisco, San Francisco, CA, USA

    Han S. Lee

Authors
  1. Emily L. Ho
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  2. S. Andrew Josephson
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  3. Han S. Lee
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  4. Wade S. Smith
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Corresponding author

Correspondence to Emily L. Ho.

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Ho, E.L., Josephson, S.A., Lee, H.S. et al. Cerebrovascular Complications of Methamphetamine Abuse. Neurocrit Care 10, 295–305 (2009). https://doi.org/10.1007/s12028-008-9177-5

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