The effect of cocaine and methamphetamine on saccular aneurysm formation and rupture: A literature review

The Clinical Impact of Recent Methamphetamine Exposure in Aneurysmal Subarachnoid Patients

“…In the United States, MA use has increased sharply over the past decade, particularly among individuals using other substances of abuse, and is responsible for nearly a quarter of drug-related treatment admissions (19,27). MA effects the central nervous system by increasing the release of serotonin, norepinephrine and dopamine into the synaptic cleft as well as inhibiting neurotransmitter degradation thereby increasing postsynaptic activity (17). Chronic MA use has wide ranging deleterious systemic effects, particularly involving the cardiovascular and cerebrovascular systems related to catecholamine toxicity, vessel in ammation, vascular remodeling and accelerated atherosclerosis (28, 29).…”

“…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].…”

“…Psychoactive drugs can have direct vascular effects in cerebral arteries, but the pathways activated by these drugs contributing to DCI after SAH have not been elucidated. (7,16,17).…”

“…Methamphetamines are synthetic amphetamine-type stimulants with potent sympathomimetic properties (18,19). Its use has been associated with a variety of cerebrovascular complications, including increased risk for aneurysm formation and rupture (17,20,21). Contradicting reports exist however on the impact of MA use on the development of vasospasm and DCI in aSAH patients, however these studies did not delineate differences between chronic and recent MA use (8,22,23).…”

Managing Subarachnoid Hemorrhage Precipitated by Anesthesia-assisted Rapid Opioid Detoxification: A Case Report

“… 4 , 5 Outside of opioid withdrawal, massive catecholamine surges have been documented as possible precipitants of subarachnoid hemorrhage. 6 Historically, treatment regimens focused on treating the acute sympathetic overdrive with alpha-2 agonists and benzodiazepines and weaning patients with long-acting opioid agonists such as methadone and buprenorphine. 7 However, concerns of limited availability and length of treatment have continued to push researchers and clinicians to search for additional strategies.…”