Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

Abstract

ABSTRACT.Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients.Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years.Setting. Inpatient and intensive care hospitalization units managing children and adolescents.Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana.Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects).Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures.Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity. Pediatrics 2004;113:e365-e370. URL: http://www.pediatrics.org/cgi/content/full/113/4/e365; ischemic stroke, cerebral blood flow, marijuana, adolescent drug use.

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

“…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.…”

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

“…Others might be systemic hypotension, instable cerebral autoregulation, instable cerebral blood flow, vacuities, cerebral vasoconstriction syndrome, and cardiac embolism with atrial fibrillation. [2,3,7,8,10] Although a few of these mechanisms may coexist, evidence explaining the causes of stroke needs to be found.…”

“…Moreover, marijuana abuse causes systemic hypertension and damage of vasomotor reflexes and the central nervous system. [10,13] Geller et al [3] reported three cases of cerebellar infarction caused by marijuana abuse. Cerebellar infarction was found by biopsy or necropsy and infi ltration of infl ammatory cells was detected in the cases.…”

“…Thus the low collateral blood flow affects the cerebellum and causes cerebellar ischemia. [3] Singh et al [8] found cerebral infarction in 17 cases of focal neurological deficit after the use of cannabis. Another study reported a 35-year-old man with unconsciousness, agitation and acute right hemiplegia after the use of cannabis, and MRI and MR angiography demonstrated an acute infarction of the middle cerebral artery.…”

“…The most wellknown substance is 8-9-THC. [1][2][3] Cannabinoids may exert their effects on the brain of humans. [4] The desired effects of cannabis are euphoria, self-confidence, relaxation, and goodness.…”