Cannabis-Related Stroke: Case Series and Review of Literature

Singh, Niranjan; Pan, Y. Albert; Muengtaweeponsa, Sombat; Geller, Thomas J.; Cruz‐Flores, Salvador

doi:10.1016/j.jstrokecerebrovasdis.2010.12.010

Cited by 85 publications

(77 citation statements)

References 36 publications

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“…The attenuated decreases in DV with MP in the marijuana abusers were observed throughout the brain but were most accentuated in cerebellum. The higher sensitivity of the cerebellum to what we interpret to reflect changes in vascular reactivity with marijuana abuse is consistent with clinical findings that report strokes associated with marijuana abuse are more frequently localized in the posterior circulation and ischemia is most frequently observed in cerebellum (25,(54)(55)(56). Cerebellar arteries express CB1 receptors in the smooth muscle layer (57), but because comparisons with arteries in other brain regions have not been done, it is not possible to determine if higher levels of CB1 receptors in cerebellar arteries underlie their higher sensitivity to vascular effects from marijuana.…”

Section: Mp-induced Changes In DVsupporting

confidence: 90%

“…To ensure that the DV responses in the controls were consistent with prior findings, we performed a secondary analysis on the effects of MP on the cerebellar DV in an independent cohort of controls, which showed a 12% reduction, and in a sample of adults with attention deficit hyperactivity disorder (ADHD), which also showed an 11% reduction (for controls of the current cohort, the cerebellar DV decrease was 13 ± 11%). The mechanism underlying the lack of an effect of MP in cerebellar DV in abusers is unclear but could reflect the effects of chronic marijuana on cerebrovascular reactivity (increased cerebral vascular resistance) (23)(24)(25), which might have prevented MP-induced vasoconstriction and associated reductions in radiotracer delivery to the brain. The attenuated decreases in DV with MP in the marijuana abusers were observed throughout the brain but were most accentuated in cerebellum.…”

Section: Mp-induced Changes In DVmentioning

confidence: 99%

“…However, prior studies are limited by their small sample sizes (ranging from six to 16 subjects). Also, prior studies did not control for the potential confounds that the changes in cerebral vascular resistance associated with marijuana abuse (23)(24)(25) could have on the delivery of the radiotracer to the brain when using a stimulant drug as pharmacological challenge, because stimulants decrease cerebral blood flow (26). Thus, the extent to which there are changes in brain DA signaling in marijuana abusers is still unclear.…”

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confidence: 99%

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Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

Volkow

Wang

Telang

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

189

147

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Moves to legalize marijuana highlight the urgency to investigate effects of chronic marijuana in the human brain. Here, we challenged 48 participants (24 controls and 24 marijuana abusers) with methylphenidate (MP), a drug that elevates extracellular dopamine (DA) as a surrogate for probing the reactivity of the brain to DA stimulation. We compared the subjective, cardiovascular, and brain DA responses (measured with PET and [ 11 C]raclopride) to MP between controls and marijuana abusers. Although baseline (placebo) measures of striatal DA D2 receptor availability did not differ between groups, the marijuana abusers showed markedly blunted responses when challenged with MP. Specifically, compared with controls, marijuana abusers had significantly attenuated behavioral ("self-reports" for high, drug effects, anxiety, and restlessness), cardiovascular (pulse rate and diastolic blood pressure), and brain DA [reduced decreases in distribution volumes (DVs) of [ 11 C]raclopride, although normal reductions in striatal nondisplaceable binding potential (BP ND )] responses to MP. In ventral striatum (key brain reward region), MP-induced reductions in DVs and BP ND (reflecting DA increases) were inversely correlated with scores of negative emotionality, which were significantly higher for marijuana abusers than controls. In marijuana abusers, DA responses in ventral striatum were also inversely correlated with addiction severity and craving. The attenuated responses to MP, including reduced decreases in striatal DVs, are consistent with decreased brain reactivity to the DA stimulation in marijuana abusers that might contribute to their negative emotionality (increased stress reactivity and irritability) and addictive behaviors.nucleus accumbens | amotivation | cannabinoid 1 receptors | brain imaging | midbrain D espite the high prevalence of marijuana consumption, the effects of marijuana abuse in the human brain are not well understood. Marijuana, like other drugs of abuse, stimulates brain dopamine (DA) signaling in the nucleus accumbens (1, 2), which is a mechanism believed to underlie the rewarding effects of drugs (3-5) and to trigger the neuroadaptations that result in addiction (reviewed in ref. 6). Indeed, in humans, imaging studies have shown that drugs of abuse increase DA release in striatum (including the nucleus accumbens), and these increases have been associated with the subjective experience of reward (7-9). However, for marijuana, the results have been inconsistent: One study reported striatal DA increases during intoxication (10); two studies showed no effects (11, 12); and one study reported DA increases in individuals with a psychotic disorder and in their relatives, but not in controls (13). Imaging studies of the brain DA system in marijuana abusers have also shown different findings from those reported for other types of substance abusers. Specifically, substance abusers (cocaine, methamphetamine, alcohol, heroin, and nicotine), but not marijuana abusers (14-16), show reduced baseline availability ...

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Section: Mp-induced Changes In DVsupporting

confidence: 90%

Section: Mp-induced Changes In DVmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

Volkow

Wang

Telang

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

189

147

View full text Add to dashboard Cite

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“…The effects on the respiratory system, central nervous system, and psychology are usually non-permanent. [2,6] Stroke associated with drug abuse has been reported in some cases, [7,8] with an incidence of 2%-39% in young patients. [9] Marijuana is the most widely abused drug, but only few reports are available on stroke associated with it.…”

Section: Introductionmentioning

confidence: 99%

Acute temporal lobe infarction in a young patient associated with marijuana abuse: An unusual cause of stroke

Inal¹,

Köse²,

Köksal³

et al. 2014

World Journal of Emergency Medicine

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“…The incidence of cerebral ischemic stroke is 0.02-0.7 % [1]. Marijuana has potent vasoconstrictor properties that act through the delta-9-tetrahydrocannabinol and cannabinoid brain receptors (CB1 and CB2), increasing glycoprotein IIb/IIIa (GPIIb-IIIa) and activating coagulation factor VII, which is a powerful thrombogenic substance [2]. Patent foramen ovale is a well-known cause of stroke [3].…”

mentioning

confidence: 99%

An unusual postoperative cerebral ischemic stroke

2014

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A 19-year-old male undergoing surgery for the correction of congenital pyelo-ureteral junction stricture suffered postoperative cerebral ischemic stroke that was confirmed by magnetic resonance imaging scans. His medical history, preoperative examinations, and response to anesthesia were unremarkable, but information obtained postoperatively revealed that he was a chronic marijuana user. Postoperative echocardiography revealed the presence of atrial septum aneurysm and patent foramen ovale, leading to the suspicion that chronic marijuana chronic use and patent foramen ovale were the causes of the cerebral ischemic stroke. The incidence of cerebral ischemic stroke is 0.02-0.7 % [1]. Marijuana has potent vasoconstrictor properties that act through the delta-9-tetrahydrocannabinol and cannabinoid brain receptors (CB1 and CB2), increasing glycoprotein IIb/IIIa (GPIIb-IIIa) and activating coagulation factor VII, which is a powerful thrombogenic substance [2]. Patent foramen ovale is a well-known cause of stroke [3]. We therefore suggest that chronic cannabis users undergoing surgery must be examined for thrombotic phenomena or stroke, hypotension and bradycardia must be treated, and anticoagulation measures must be undertaken preoperatively.

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Cannabis-Related Stroke: Case Series and Review of Literature

Cited by 85 publications

References 36 publications

Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

Acute temporal lobe infarction in a young patient associated with marijuana abuse: An unusual cause of stroke

An unusual postoperative cerebral ischemic stroke

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