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Haemorrhagic stroke related to the use of 4-fluoroamphetamine

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Abstract

Introduction

The use of the new psychoactive substance 4-fluoroamphetamine (4-FA) and the number of 4-FA-related intoxications substantially increased in The Netherlands in recent years. We describe two patients with severe 4-FA-related complications and the characteristics of a large sample of 4-FA-intoxicated patients.

Methods

Information on patients with 4-FA-related intoxications between January 2009 and June 2017 was available from the Monitor Drug-related Incidents. Detailed clinical information was obtained of two patients with haemorrhagic stroke after toxicologically confirmed 4-FA use.

Results

We report on two patients who presented with headache and mild hypertension after 4-FA use. Patient A developed one-sided weakness and decreased consciousness after a few hours. A computed tomography scan showed a left-sided intracerebral haemorrhage. Because of life-threatening cerebral herniation, haematoma evacuation was performed. Postoperatively, she suffered from a right-sided hemiparalysis and severe aphasia, requiring clinical rehabilitation. Patient B had a subarachnoid haemorrhage without neurological deficits. In total, 939 4-FA-intoxicated patients were registered. These patients used 4-FA alone (44%) or in combination with alcohol (13%) and/or other drugs (43%).

Discussion

Patients using 4-FA are at risk for life-threatening health problems, including intracranial haemorrhage. Additional brain imaging should be considered in 4-FA-intoxicated patients, not only in the presence of neurological deficits, but also in the case of severe headache.

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Acknowledgements

We are grateful to the patients for giving their consent. We also thank E. J. P. Franssen, Head of the Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands, for analysing the urine samples of the patients. The Monitor Drug-related Incidents is financially supported by the Dutch Ministry of Health, Welfare, and Sport.

Author information

Authors and Affiliations

  1. Department of Drug Monitoring and Policy, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), 725, 3500 AS, Utrecht, The Netherlands

    C. H. W. Wijers, R. J. M. Niesink & Esther A. Croes

  2. Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands

    M. C. Visser

  3. Event Medical Service, Uden, The Netherlands

    R. T. H. van Litsenburg

  4. Faculty of Management, Science and Technology, School of Science, Open University of the Netherlands, Heerlen, The Netherlands

    R. J. M. Niesink

  5. Department of Neurosurgery, VU University Medical Centre, Amsterdam, The Netherlands

    R. B. Willemse

Authors
  1. C. H. W. Wijers
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  2. M. C. Visser
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  3. R. T. H. van Litsenburg
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  4. R. J. M. Niesink
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  5. R. B. Willemse
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  6. Esther A. Croes
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Corresponding author

Correspondence to Esther A. Croes.

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Ethical standards

The local ethics committee confirmed that analyses of the anonymous data from the MDI database do not require separate ethics approval. Written informed consent was received from both presented patients. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Wijers, C.H.W., Visser, M.C., van Litsenburg, R.T.H. et al. Haemorrhagic stroke related to the use of 4-fluoroamphetamine. J Neurol 265, 1607–1611 (2018). https://doi.org/10.1007/s00415-018-8888-6

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  • DOI: https://doi.org/10.1007/s00415-018-8888-6

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