Skip to main content
SpringerLink
Log in

Fatal hemorrhage complicated with methamphetamine poisoning and its post-mortem CT features

  • Original Article
  • Published:
Forensic Science, Medicine and Pathology Aims and scope Submit manuscript

Abstract

The purpose of this study was to assess the incidence of fatal hemorrhage complicated with methamphetamine (MA) poisoning and to examine the postmortem computed tomography (PMCT) features of fatal intracerebral hemorrhage (ICH) with and without MA poisoning. The study also attempted to determine the differences in PMCT between those two groups. Consecutive medicolegal autopsy data from November 2011 to February 2018 were searched for 3044 cases. First, the incidence and distribution of all cases of nontraumatic fatal hemorrhage with various causes were examined. Second, cases of ICH on the basal ganglia and brain stem were extracted. The PMCT findings were compared with respect to nine parameters: volume of hematoma, ventricular perforation, midline shift distance, aortic calcification, calcification of aortic valve, calcification of coronary artery, cardiothoracic ratio, circumference of ascending aorta, and volume of bladder contents. Of the 3044 cases, 97 were nontraumatic fatal hemorrhage; of these 97 cases, 20 were classified as MA poisoning with 9 ICH cases, and 60 cases were classified as non-MA poisoning with 14 ICH cases. A statistically significant difference in ages was observed between the two groups. On PMCT comparison of ICH, statistically significant differences were evident in the midline shift distance and calcification of the aortic valve. Forensic radiologists should be aware of the possibility of ICH with MA poisoning if fatal hemorrhage is detected on PMCT. Younger age, less calcification of the aortic valve, and a remarkable midline shift may be the keys to recognition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. United Nations Office on Drugs and Crime. World drug report 2016. New York: United Nations; 2016. https://www.unodc.org/wdr2018/

    Book  Google Scholar 

  2. Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD, et al. Global burden of disease attributable to illicit drug use and dependence: findings from the global burden of disease study 2010. Lancet. 2013;382:1564–74.

    Article  Google Scholar 

  3. Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27:253–62.

    Article  Google Scholar 

  4. Callaghan C, Cunningham JK, Verdichevski M, et al. All-cause mortality among individuals with disorders related to the use of methamphetamine: a comparative cohort study. Drug Alcohol Depend. 2012;125:290–4.

    Article  Google Scholar 

  5. O’Donnell C, Woodford N. Post-mortem radiology - a new-subspecialty? Clin Radiol. 2008;63:1189–94.

    Article  Google Scholar 

  6. Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, et al. Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) - a feasibility study. J Forensic Sci. 2003;48:386–403.

    PubMed  Google Scholar 

  7. Takahashi N, Higuchi T, Shiotani M, Satou S, Hirose Y. Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments. Jpn J Radiol. 2011;29:701–6.

    Article  Google Scholar 

  8. McGee SM, McGee DN, McGee MB. Spontaneous intracerebral hemorrhage related to methamphetamine abuse: autopsy findings and clinical correlation. Am J Forensic Med Pathol. 2004;25:334–7.

    Article  Google Scholar 

  9. Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry. 2017;88:1079–91.

    Article  Google Scholar 

  10. Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry. 2007;64:495–502.

    Article  Google Scholar 

  11. McEvoy AW, Kitchen ND, Thomas DG. Intracerebral hemorrhage and drug abuse in young adults. Br J Neurosurg. 2000;14:449–54.

    Article  CAS  Google Scholar 

  12. de los Ríos F, Kleindorfer DO, Khoury J, Broderick JP, Moomaw CJ, Adeoye O, et al. Trends in substance abuse preceding stroke among young adults: a population-based study. Stroke. 2012;43:3179–83.

    Article  Google Scholar 

  13. Ho EL, Josephson SA, Lee HS, Smith WS. Cerebrovascular complications of methamphetamine abuse. Neurocrit Care. 2009;10:295–305.

    Article  Google Scholar 

  14. Beadell NC, Thompson EM, Delashaw JB, Cetas JS. The deleterious effects of methamphetamine use on initial presentation and clinical outcomes in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2012;117:781–6.

    Article  Google Scholar 

  15. Huang MC, Yang SY, Lin SK, Chen KY, Chen YY, Kuo CJ, et al. Risk of cardiovascular diseases and stroke events in methamphetamine users: a 10-year follow-up study. J Clin Psychiatry. 2016;77:1396–403.

    Article  Google Scholar 

  16. Darke S, Lappin J, Kaye S, Duflou J. Clinical characteristics of fatal methamphetamine –related stroke: a National Study. J Forensic Sci. 2018;63:735–9.

    Article  CAS  Google Scholar 

  17. Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics. Crit Care. 2012;16:R136.

    Article  Google Scholar 

  18. Tormoehlen LM, Blatsioris AD, Moser EA, Carter RJ, Stevenson A, Ofner S, et al. Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage. Neurology. 2017;88:252–8.

    Article  Google Scholar 

  19. Bentur Y, Bloom-Krasik A, Raikhlin-Eisenkraft B. Illicit cathinone (“Hagigat”) poisoning. Clin Toxicol. 2008;46:206–10.

    Article  CAS  Google Scholar 

  20. Rose DZ, Guerrero WR, Mokin MV, Gooch CL, Bozeman AC, Pearson JM, et al. Hemorrhagic stroke following use of the synthetic marijuana ‘spice’. Neurology. 2015;85:1177–9.

    Article  Google Scholar 

  21. Gee P, Tallon C, Long N, Moore G, Boet R, Jackson S. Use of recreational drug 1,3 dimethylamylamine (DMAA) associated with cerebral hemorrhage. Ann Emerg Med. 2012;60:431–4.

    Article  Google Scholar 

  22. Kaye S, McKetin R, Duflou J, Darke S. Methamphetamine and cardiovascular pathology: a review of the evidence. Addiction. 2007;102:1204–11.

    Article  Google Scholar 

  23. Rye KA, Barter PJ, Brown AJ. Speed kills in more ways than one: methamphetamine and atherosclerosis. Atherosclerosis. 2015;243:654–5.

    Article  CAS  Google Scholar 

  24. The annual report of National Police Agency in Japan, 2018. https://www.npa.go.jp.

Download references

Acknowledgments

We thank Hisako Saitoh, Yukiko Oya, Keisuke Okaba, Katsura Otsuka, Yuriko Oodo, Miyuki Miura, and Kazuhiro Kobayashi for their technical support.

Author information

Authors and Affiliations

  1. Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, Japan

    Maiko Yoshida, Yohsuke Makino, Yumi Hoshioka, Fumiko Chiba, Go Inokuchi, Suguru Torimitsu, Rutsuko Yamaguchi, Hiroko Abe & Hirotaro Iwase

  2. Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan

    Yohsuke Makino, Fumiko Chiba, Suguru Torimitsu & Hirotaro Iwase

  3. Department of Legal Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba Prefecture, Japan

    Ayumi Motomura & Daisuke Yajima

Authors
  1. Maiko Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yohsuke Makino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yumi Hoshioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fumiko Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Go Inokuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suguru Torimitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rutsuko Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ayumi Motomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroko Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Daisuke Yajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hirotaro Iwase
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maiko Yoshida.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

A man aged in his 50s was found dead at home wearing only underwear. Criminal record of methamphetamine (MA) abuse (+). Circumstantial evidence included a used syringe (+). The blood concentration of MA was 3.4 μg/mL. (a) and (b) Superficially, an injection scar and fresh injection site were detected (arrows). (c) On postmortem computed tomography, massive hemorrhage was detected on the pons. (d) At autopsy, massive hemorrhage on the pons was confirmed. (PNG 719 kb)

High Resolution (TIF 902 kb)

ESM 2

A female aged in her 50s was found dead at home. Criminal record of methamphetamine (MA) abuse (−). Circumstantial evidence included a used syringe (−). The blood concentration of MA was 0.45 μg/mL. (a) Superficially, an injection scar and fresh injection site were not detected. (b) On postmortem computed tomography, subarachnoid hemorrhage (SAH), mainly located on the basal cistern, was detected. (c) At autopsy, SAH caused by aneurysm rupture of the left vertebral artery was confirmed. (d) Enlarged image of the rupture site of the left vertebral artery (arrow). (PNG 768 kb)

High Resolution (TIF 1012 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, M., Makino, Y., Hoshioka, Y. et al. Fatal hemorrhage complicated with methamphetamine poisoning and its post-mortem CT features. Forensic Sci Med Pathol 16, 577–585 (2020). https://doi.org/10.1007/s12024-020-00294-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-020-00294-5

Keywords

Search

Navigation