Impact of Methamphetamine Abuse: A Rare Case of Rapid Cerebral Aneurysm Growth with Review of Literature

Fowler, James B.; Quadri, Syed A.; Cortez, Vladimir; Frooqui, Mudassir; Zafar, Atif; Ahmed, Fahad Shabbir; Agrebi, I.; Ramachandran, Anirudh; Siddiqi, Javed

doi:10.1155/2018/1879329

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…In addition to hypertension, a direct effect of methamphetamine and related molecules such as beta-aminopropionitrile on the vasculature has been characterized, including a necrotizing angiitis, 26,27 neurovascular inflammation and weakening of vessel walls via matrix metalloproteases and inflammatory cytokines. 28–30 Also, rapid growth of intracranial aneurysms after methamphetamine abuse 28 , 31 has been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

et al. 2020

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Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

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Section: Discussionmentioning

confidence: 99%

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

et al. 2020

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“…In contrast, posterior circulation aneurysms were noted in 21 (20%) of patients in the MA absent cohort, with three (14.3%) having vasospasm exclusively involving the posterior circulation and 12 (57.1%) with both posterior and anterior circulation vasospasm. Use of MA has been linked with increased risk of aneurysm formation as well as accelerated growth, abnormal morphological changes and rupture, likely owing to direct toxic effects on the vasculature leading to in ammation and impaired vessel wall integrity (17,39,40). Although multiple prior studies did not nd an interaction between MA use and aneurysm location, a recently published large case series of MA related aneurysms found that while anterior circulation aneurysms were more common overall (77%), posterior aneurysms were disproportionately more likely to present with rupture compared to anterior aneurysms (65% vs 32%) and rupture despite smaller size (8, [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Impact of Recent Methamphetamine Exposure in Aneurysmal Subarachnoid Patients

Vitt

Cheng

Chung

et al. 2023

Preprint

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Background Methamphetamines (MA) are a frequently used drug class with potent sympathomimetic properties that can affect cerebral vasculature. Conflicting reports in literature exist about the effect of exposure to MA on vasospasm risk and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to characterize the impact of recent MA use on the timing, severity and features of vasospasm in aneurysmal subarachnoid as well as neurological outcomes. Methods We retrospectively screened 441 consecutive patients admitted to a tertiary care hospital with a diagnosis of SAH who underwent at least one cerebral digital subtraction angiogram (DSA). Patients were excluded if no urinary toxicology screen was performed within 24 hours of admission, if there was a diagnosis of non-aneurysmal SAH, or if ictus was greater than 72 hours from hospital admission. Vasospasm characteristics were collected from DSA and transcranial doppler (TCD) studies and demographic as well as clinical outcome data was abstracted from the chart. Results 129 patients were included and 24 tested positive for MA. Among the 312 excluded patients, 281 did not have a urinary toxicology screen and 31 had a non-aneurysmal pattern of SAH or ictus occurring greater than 72 hours from hospital admission. No significant differences were found in respect to patient age, sex, or admission Hunt and Hess Score or Modified Fisher Scale based on MA use. There was no difference in the severity of vasospasm or time to peak severity using either TCD or DSA criteria on multivariate analysis. Aneurysms were more likely to be in the anterior circulation for both groups, however the MA cohort experienced less vasospasm involving the anterior circulation and more isolated posterior circulation vasospasm. There was no difference in delayed cerebral ischemia (DCI) incidence, length of ICU stay, need for ventriculoperitoneal shunt placement, functional outcome at discharge or hospital mortality. Interpretation: Recent MA use was not associated with worse vasospasm severity, time to vasospasm, or DCI in aSAH patients. Further investigations about localized MA effects in the posterior circulation and impact on long-term functional outcomes are warranted.

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“…We speculate that the patient may have experienced a rare sudden enlargement of the aneurysm after the second onset of symptoms, as previously described by Miller et al [ 11 ] and Khan et al [ 12 ]. Previous reports of the rapid growth of cystic aneurysms show that this condition often occurs in patients with atrial myxoma, inflammatory aneurysms, drug abuse, and blood vesicular aneurysms[ 13 - 16 ], and its causes have been reported to be related to pregnancy, surgery, hypertension, and sex[ 17 , 18 ]. However, all of the aforementioned factors were excluded based on the patient’s medical history, except a suspicious history of trauma.…”

Section: Discussionmentioning

confidence: 99%

Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report

Zhao¹,

Zhao²,

Tang³

2021

WJCC

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BACKGROUND Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health. Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous consequences in some patients. To date, ruptured intracranial aneurysms have been misdiagnosed as meningitis, tumors, stroke, or trauma, among other conditions. Here, we report what appears to be the first case of a ruptured intracranial aneurysm that presented as cerebral circulation insufficiency. CASE SUMMARY A middle-aged man was admitted to our hospital because of a parasellar lesion identified on a noncontrast computed tomography (CT) image after a mild traffic accident that was caused by a brief loss of consciousness. Notably, he was diagnosed with cerebral circulation insufficiency after two unexplained episodes of a transient loss of consciousness within the past 8 mo. The patient was diagnosed with right internal carotid artery aneurysm based on CT angiography and completely recovered after a craniotomy at our hospital. A few clots and severe adhesions around the aneurysm were observed in the subarachnoid space during the operation, suggesting that the aneurysm had ruptured and may had been misdiagnosed as cerebral circulation insufficiency. CONCLUSION Ruptured intracranial aneurysms may show negative imaging results and present as cerebral circulation insufficiency, which should be recognized as soon as possible to ensure timely management.

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Impact of Methamphetamine Abuse: A Rare Case of Rapid Cerebral Aneurysm Growth with Review of Literature

Cited by 9 publications

References 31 publications

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

The Clinical Impact of Recent Methamphetamine Exposure in Aneurysmal Subarachnoid Patients

Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report

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