Cerebrovascular complications of methamphetamine abuse.
OBJECTIVE
Methamphetamine is a stimulant widely abused in the United States. The objective of this study was to demonstrate an association of methamphetamine use and ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage and to further reveal the underlying vascular pathology using neuroimaging and pathology.


METHODS
This was a retrospective study based on medical chart review of admissions to the neurovascular service of a tertiary care medical center from January 2003 to July 2007. Cases included patients who used methamphetamine as documented by history or urine toxicology screening.


RESULTS
From 1,574 records, 30 cases were identified. The mean age of patients was 43 years and the discharge diagnoses included ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. All subarachnoid hemorrhages were aneurysmal with the majority of the aneurysms located in the anterior circulation. The majority of strokes were located in the anterior circulation. In many cases, radiologic imaging confirmed arterial stenoses in the vascular distribution of the stroke. One patient who presented with ischemic stroke had severe atherosclerosis of bilateral common, internal, and external carotid arteries. On pathology, there was no evidence of inflammation or necrosis to suggest vasculitis as a possible etiology.


CONCLUSIONS
Methamphetamine use is associated with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, especially among young patients. We showed no evidence that the ischemic stroke associated with methamphetamine use is due to an inflammatory etiology but may be due to a process of accelerated atherosclerosis.
Ho
Emily L
EL
Department of Neurology, University of California San Francisco, 1001 Potrero Ave., SFGH 4M62, Box 0870, San Francisco, CA 94143-0870, USA. emily.ho@ucsf.edu.
Josephson
S Andrew
SA
Lee
Han S
HS
Smith
Wade S
WS
D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D050197:Atherosclerosis / Q000150:complications / Q000401:mortality / Q000473:pathology; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D000697:Central Nervous System Stimulants; D008694:Methamphetamine