title: Ischemic stroke after use of the synthetic marijuana "spice".
abstract: OBJECTIVE
  To report and associate acute cerebral infarctions in 2 young, previously healthy siblings with use of the street drug known as "spice" (a synthetic marijuana product, also known as "K2"), which they independently smoked before experiencing acute embolic-appearing ischemic strokes.
  
  
  METHODS
  We present history, physical examination, laboratory data, cerebrovascular imaging, echocardiogram, ECG, and hospital course of these patients.
  
  
  RESULTS
  We found that in both siblings spice was obtained from the same source. The drug was found to contain the schedule I synthetic cannabinoid JWH-018. Full stroke workup was unrevealing of a stroke etiology; urine drug screen was positive for marijuana.
  
  
  CONCLUSIONS
  We found that our 2 patients who smoked the street drug spice had a temporal association with symptoms of acute cerebral infarction. This association may be confounded by contaminants in the product consumed (i.e., marijuana or an unidentified toxin) or by an unknown genetic mechanism. The imaging of both patients suggests an embolic etiology, which is consistent with reports of serious adverse cardiac events with spice use, including tachyarrhythmias and myocardial infarctions.
authors.affiliation: From the Department of Neurology, University of South Florida, Tampa.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Freeman
authors.forename: David Z
authors.initials: DZ
authors.lastname: Rose
authors.forename: Martin A
authors.initials: MA
authors.lastname: Myers
authors.forename: Clifton L
authors.initials: CL
authors.lastname: Gooch
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Bozeman
authors.forename: W Scott
authors.initials: WS
authors.lastname: Burgin
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007211:Indoles / Q000009:adverse effects*; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects*; D009281:Naphthalenes / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D013287:Illicit Drugs; D007211:Indoles; D009281:Naphthalenes; C552597:1-pentyl-3-(1-naphthoyl)indole