A case of recurrent stroke associated with cannabis use

Cannabis could increase the risk of cerebrovascular accident (CVA) of ischemic origin in young consumers assume that Spanish doctors and describe the case of a patient who suffered three recurrent stroke immediately after smoking cannabis.

The misuse of drugs, mostly cocaine, heroin and amphetamines, is a risk factor for stroke, especially among young people, said the team of Dr. Juan Carlos Garcia-Monco the hospital Galdacano in "Journal of Neurology, Neurosurgery and Psychiatry."

But the association between cerebrovascular disease and cannabis is "exceptional" as it is the most abused drug in the world, say the researchers. In the literature, only 15 cases have been described.

However, the Spanish doctors reported a case where a clear temporal relationship appears between cannabis use and stroke occurred on three separate occasions, with an unusual take a significant amount of cannabis combined with three or four glasses of alcohol during a party.

It is a 36 year old man without known cardiovascular risk factor or a history of migraine, having ever used cannabis occasionally. Neurological symptoms developed in three occasions occurred immediately after taking cannabis.

The first time, the patient had an acute episode of isolated aphasia followed a few hours after a seizure episode. MRI revealed two acute ischemic stroke, one in the left temporal lobe corresponding to neurological deficit, and the other, silent, in the right parietal lobe.

Examinations excluded the use of other drugs and the absence of diffuse atherosclerotic disease. Seizures do not recur. The patient was treated with antiplatelet therapy.

Despite this treatment, and the warning against the use of drugs, the patient underwent a new episode of aphasia and right hemiparesis a year later. MRI showed a new acute stroke at the left frontal cortex, responsible for the symptoms, and another silent ischemic stroke over the contralateral frontal lobe.

For a year and a half, the young man remained abstinent then a new party, he developed an auditory agnosia. A MRI appeared a stroke involving the posterior temporal and inferior parietal lobes.

The patient recovered and since then his condition remained stable during treatment. He assured not consume cannabis.

Data on the patient strengthen the association between stroke and cannabis because of the close temporal relationship between stroke and three repeated use of the drug, involving different arterial territories, the absence of embolic source or atherosclerotic disease and good patient recovery after stopping taking the product, the authors write.

The latter believe that cannabis "may be associated" with the risk of ischemic stroke in young people, as yet unexplained mechanisms, toxic or inflammatory vasculopathy caused by cannabis, they assume. In the case described, the concomitant use of alcohol may also have played a role, they add.

Toxicology testing including research cannabinoids and should be performed in young stroke patients, they suggest.

However, further studies are necessary, because the role of cannabis in stroke may be underestimated. Spanish doctors even fear that this risk increases with increased consumption of cannabis because of its potential therapeutic benefits and its possible legal in some countries.

Dr. Dominique Delplanque the Lille University Hospital said the study provides "for the first time," a "highly plausible" causal relationship between cannabis use and cerebrovascular events.

The recreational use of cannabis does not seem as harmless as we thought, which involves improving public information, he says. The risk / benefit of cannabis for therapeutic purposes report should also be rigorously evaluated before allowing its commercialization, he adds.