Intracerebral Hemorrhage From an Arteriovenous Malformation After Amphetamine Injection

Lukes, Steven A.

doi:10.1001/archneur.1983.04050010080027

Cited by 42 publications

(8 citation statements)

References 7 publications

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“…In a few isolated instances, angiography has revealed a coincidental AVM or aneurysm as the source of hemorrhage, which has been parenchymatous or subarachnoid, respectively. 44 ' 45 In these instances, the apparent role of the drug has been that of the precipitant rather than the actual cause of the hemorrhage.…”

Section: Use Of Amphetamines and Othermentioning

confidence: 99%

Intracerebral hemorrhage: non-hypertensive causes.

Kase¹

1986

Stroke

110

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SPONTANEOUS, non-traumatic intracerebral hemorrhage (ICH) in the adult is most commonly secondary to hypertensive cerebrovascular disease. In 70-90% of cases of spontaneous ICH, arterial hypertension is the presumed cause.1 These hypertensive hemorrhages show a predilection for certain anatomic locations: the basal ganglia (the putamen in particular), the subcortical white matter, and the thalamus account for 35%, 25%, and 20% of ICHs, respectively, whereas the posterior fossa locations, the cerebellum and pons, are responsible for only 10% and 5% of the cases.2 Irrespective of their anatomic locations, the common pathogenesis in these hemorrhages involves the hypertension-induced degeneration of the media of small (50-200 micra) arteries called "lypo-hyalinosis," 3 and/ or the formation of "microaneurysms", both of which occur preferentially in perforating or small sub-cortical arteries, thus resulting in the characteristic anatomic distribution of hypertensive ICH.A significant number of cases of ICH are due to causes other than hypertension. The frequency of such cases varies from 25% to 50% among series, and depends on the anatomic type of ICH being considered: non-hypertensive mechanisms may account for as many as 55% of "lobar" ICH cases, 4 ' 3 while pontine hemorrhage is virtually always (90%) hypertensive, and the deep ganglionic (putaminal, thalamic) and cerebellar varieties occupy an intermediate position (35%, 25%, and 38% being of non-hypertensive mechanism, respectively). Among the many possible mechanisms of ICH not primarily related to hypertension, there are several that occur with high enough frequency to warrant separate discussion. These causes of ICH are related to special types of arterial pathology, to the presence of brain tumors, or to the use of medications, and include: cerebral amyloid angiopathy, small vascular malformations, primary or metastatic brain tumors, oral anticoagulants, and amphetamines and a variety of other sympathomimetic drugs. Cerebral Amyloid AngiopathyThis condition is a unique form of angiopathy due to deposits of amyloid in the media and adventitia of

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Section: Use Of Amphetamines and Othermentioning

confidence: 99%

Intracerebral hemorrhage: non-hypertensive causes.

Kase¹

1986

Stroke

110

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“…Most reported patients use the drug orally or intrave nously. The most frequent stroke patterns are intracere bral hemorrhage (ICH) [1-3, 6, 8, 9, 12], subarachnoid hemorrhage (S AH) [I, 5,7,10] and a combination of both [1,4], Although autopsy studies have found ischemic lesions in some patients [13], a clinically ischemic stroke has never been reported in oral or intravenous amphet amine abusers [14].…”

Section: Introductionmentioning

confidence: 99%

Stroke Associated with Methamphetamine Inhalation

Yen

Wang

et al. 1994

Eur Neurol

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Seven patients (all men, mean age 32 years, range 17-47) with stroke following methamphetamine inhalation were collected during the last 2 years. Like oral or intravenous abusers, our patients had more hemorrhagic (n = 5) than ischemic strokes (n = 2). Cases of intracerebral hemorrhage (ICH) were lobar (n = 3), caudate (n = 1) or putaminal (n = 1), whereas the infarctions were both in the middle cerebral artery region. Each stroke event occurred within 3 days after drug use. Three patients had hypertension on admission. Though young in age, most patients had multiple stroke risk factors. In 3 patients with ICH, we also found small, low attenuated lesions on the brain computed tomography, however, without clinical correlations. Except for arteriovenous malformation in 1 patient, all angiograms failed to show vasculopathy or vasospasm. Contrary to what one might surmise from previously published reports, methamphetamine inhalation is at least as likely to produce ICH as it is to produce brain infarction.

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“…There have, however, been two recent reports of ruptured arteriovenous malformations after amphetamine misuse and a single case after ecstasy misuse 10 13. The growing pandemic of cocaine use in Western society is providing increasing evidence of its association with intracerebral haemorrhage 14 – 19.…”

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confidence: 99%