Transient Ischemic Attack in Heavy Cannabis Smokers – How ‘Safe’ Is It?

Abstract

Drugs are lately considered high-risk factors for cerebrovascular disease. Three male patients (mean age 24.6 years) who were heavy cannabis smokers presented with transient ischemic attacks (TIA) shortly after cannabis abuse. The complete examination of all 3 consisted of: EEG, brain CT scan, brain MRI, cerebral vessel angiography (digital subtraction and magnetic resonance angiography); also a full cerebrospinal fluid, urine and blood analysis (immunological, biochemical and hormonal tests were included). Urine was further examined for drug metabolites. An extensive cardiological investigation was carried out. Small vessel leukoencephalopathy was revealed by the brain CT and MRI. EEG recordings of the first patient showed paroxysmal sharp waves with left hemispheric dominance. The other 2 patients had diffuse delta and theta activity in their EEG tracings. The urine analysis was positive for cannabis metabolites. There were no other abnormal findings in the rest of the meticulous and thorough study of all 3 patients, which leads to the conclusion that cannabis was the only risk factor responsible for the observed TIA, contradictory to other studies, which support that cannabis is a ‘safe’ drug. More research is required in order for this issue to be completely elucidated.

Cannabis-related Stroke

“…Most of stroke were IS (n=49) 11,12,[14][15][16][17][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] or transient ischemic attacks (n=5). 14,38,39 There is only 1 patient who was described with an hemorrhagic stroke associated with cannabis use. 40 For 4 patients, a diagnosis for stroke was suspected but not confirmed because there was no neuroimaging.…”

Effects of marijuana on neurophysiological signals of working and episodic memory

“…Although the results on myriad perceptual, psychomotor, and cognitive tasks have been equivocal, a consistent finding is impaired performance on relatively difficult tests of memory over periods of a few seconds to several minutes. Whereas the effects of marijuana smoking on brain function have been studied using EEG (Lukas et al 1995;Solowij 1995), PET (Mathew et al 1998;O'Leary et al 2002), and MRI measures (Block et al 2000;Mouzak et al 2000), studies measuring brain activity during the performance of difficult memory tasks are still lacking. A recent review stated that "despite the obvious importance of the abundant CB1 receptors in the neocortex there have so far been few electrophysiological studies of their effects on neural activity" (Iversen 2003(Iversen , p. 1258.…”

Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty?

“…Meanwhile, transient cerebral ischemic events and strokes following marijuana use have also been reported [37][38][39][40]. In a recent report of three patients with ischemic episodes, all had normal angiograms suggesting a role for cerebral vasospasm in susceptible individuals [41].…”