Neurocritical Care

, Volume 10, Issue 3, pp 295–305

Cerebrovascular Complications of Methamphetamine Abuse

  • Emily L. Ho
  • S. Andrew Josephson
  • Han S. Lee
  • Wade S. Smith
ORIGINAL ARTICLE

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.

Keywords

Cerebrovascular disease/stroke Infarction Intracerebral hemorrhage Subarachnoid hemorrhage Stroke in young adults Methamphetamine 

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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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Emily L. Ho
    • 1
  • S. Andrew Josephson
    • 2
  • Han S. Lee
    • 3
  • Wade S. Smith
    • 2
  1. 1.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of PathologyUniversity of California San FranciscoSan FranciscoUSA

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