Cannabis-related Stroke

Wolff, Valérie; Armspach, Jean‐Paul; Lauer, V.; Rouyer, Olivier; Bataillard, Marc; Marescaux, Christian; Gény, Bernard

doi:10.1161/strokeaha.112.671347

Cited by 110 publications

(67 citation statements)

References 51 publications

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“…Recently, a growing body of research has linked cannabis use to stroke, particularly to those occurring before 45 years of age. 6,7 It seems cannabis-associated strokes usually occur in chronic or current cannabis users who also smoke tobacco, 8 either in combination with or immediately after cannabis use. The cerebrovascular effects of cannabis highlighted as possible mechanisms for subsequent strokes include hypotension, altered cerebral vasomotor function, vasospasm, cerebral vasoconstriction, and swings in blood pressure.…”

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confidence: 99%

“…However, currently there is a dearth of epidemiological data supporting an association between cannabis use and stroke. 8,9 Thus, our current knowledge about cannabis-associated strokes is based almost exclusively on clinical reports. 10 Although there have been a few general population studies, these have been mostly based on hospital records and are, therefore, retrospective in nature.…”

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confidence: 99%

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Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke

Falkstedt

Wolff

Allebeck

et al. 2017

Stroke

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Background and Purpose-Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol. Methods-The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age. Results-No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88). Conclusions-We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

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confidence: 99%

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confidence: 99%

Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke

Falkstedt

Wolff

Allebeck

et al. 2017

Stroke

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“…Limitations to our report include the possibility that the spice was not the etiology of these siblings' strokes; an unidentified genetic mechanism was responsible given their relation; that the timing, use, and identical supplier of spice to each patient was coincidental; that unidentified toxins in the spice provoked their strokes; that they experienced a synergistic toxic effect of natural marijuana with its synthetic counterpart JWH-018; or that the etiology was marijuana itself. Although cannabis use is not conventionally associated with stroke, emerging case reports describe cerebral infarction with significant marijuana intake, 10 especially after myocardial infarction and typically soon after smoking the marijuana. Uncoincidentally, the increase in interest in marijuana-related stroke has occurred simultaneously with an increase in the use of spice, which is undetectable in conventional toxicologic studies.…”

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confidence: 99%

Ischemic stroke after use of the synthetic marijuana “spice”

et al. 2013

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Objectives: To report and associate acute cerebral infarctions in 2 young, previously healthy siblings with use of the street drug known as "spice" (a synthetic marijuana product, also known as "K2"), which they independently smoked before experiencing acute embolic-appearing ischemic strokes.Methods: We present history, physical examination, laboratory data, cerebrovascular imaging, echocardiogram, ECG, and hospital course of these patients.Results: We found that in both siblings spice was obtained from the same source. The drug was found to contain the schedule I synthetic cannabinoid JWH-018. Full stroke workup was unrevealing of a stroke etiology; urine drug screen was positive for marijuana.Conclusions: We found that our 2 patients who smoked the street drug spice had a temporal association with symptoms of acute cerebral infarction. This association may be confounded by contaminants in the product consumed (i.e., marijuana or an unidentified toxin) or by an unknown genetic mechanism. The imaging of both patients suggests an embolic etiology, which is consistent with reports of serious adverse cardiac events with spice use, including tachyarrhythmias and myocardial infarctions. Spice, a schedule I synthetic marijuana (also known as "K2"), is a recreational street drug with many known adverse effects, including seizures and myocardial infarction. However, to our knowledge, cerebral infarction associated with synthetic marijuana use has yet to be reported in the medical literature. Spice is frequently abused by young adults with increasing popularity because of its euphoric effects and the ease with which it is obtained, which creates the perception of "a legal high." The US Drug Enforcement Agency (DEA), law enforcement, hospitals, and poison control centers have noted gradually increasing use of spice in the United States since 2009. In 2011, 5 synthetic cannabinoids used in spice were categorized as schedule I substances under the Controlled Substances Act: JWH-018; JWH-073; 497; and cannabicyclohexanol. 1 At the time of our patients' presentations, spice was available for sale over-the-counter at convenience stores, smoke shops, gas stations, and over the Internet, and labeled as "herbal blends," "air fresheners," or "incense," often with the warning "not for human consumption."2 Common side effects of spice include tachycardia, vomiting, agitation, confusion, and hallucinations; more serious adverse reactions (seizures, myocardial infarction) have recently appeared in the medical literature. 2-4Furthermore, a number of spice-associated deaths have been reported in national news media. To our knowledge, the medical literature has not yet reported ischemic stroke associated with synthetic marijuana. We present 2 young siblings who experienced acute ischemic strokes soon after smoking synthetic marijuana.CASE REPORTS Patient A. A 26-year-old man was brought to the emergency department by emergency medical services approximately 50 minutes after he had the sudden onset of dysarthria, expressive ...

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“…To our knowledge, spice-associated ICH has not been reported. Although our patients denied severe headaches, DSA showing early, transient vasospasm soon after ingestion suggests a reversible cerebral vasoconstriction syndrome-like mechanism, one of many proposed pathophysiologies for AIS associated with both cannabis 4 and spice. 5 Cannabinoids can rapidly alter neurotransmitter release from nerve terminals, potently activating vascular smooth muscle cells while disrupting endothelial cell function, potentially resulting in both ischemia and hemorrhage.…”

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confidence: 57%