title: A case of acute cerebral ischemia following inhalation of a synthetic cannabinoid.
abstract: OBJECTIVE
  Synthetic cannabinoids are increasingly used in the United States as marijuana substitutes. However, reports of severe toxicity, resulting from their use, are limited. We present the case of acute cerebral infarction following synthetic cannabinoid inhalation.
  
  
  METHODS
  A 33-year-old man with no significant medical history presented at the emergency department with right-sided weakness and aphasia. He had smoked a synthetic cannabinoid (SC) product called "WTF" prior to the onset of symptoms. Physical examination showed right hemiparesis, dysarthria, and aphasia. Laboratory evaluation, electrocardiography, and computed tomography (CT) of the head were unremarkable. Following administration of intravenous tissue plasminogen activator, his symptoms improved. A repeat head CT showed acute infarction in the left insular cortex. His hypercoagulability panel was unremarkable, and the patient was discharged neurologically intact. Urine toxicology results were unremarkable. Analysis of the product by gas chromatography-mass spectrometry (GC-MS) procedure confirmed the presence of a synthetic cannabinoid known as XLR-11.
  
  
  CONCLUSIONS
  XLR-11 has previously been associated with acute kidney injury in humans. However, there are no reports of it causing acute cerebral ischemic events. The close temporal association between XLR-11 inhalation and his stroke is concerning. Acute cerebral infarction may occur after XLR-11 use in healthy patients.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine , New York, NY , USA.
authors.forename: M
authors.initials: M
authors.lastname: Takematsu
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: L S
authors.initials: LS
authors.lastname: Nelson
authors.forename: J M
authors.initials: JM
authors.lastname: Schechter
authors.forename: J H
authors.initials: JH
authors.lastname: Moran
authors.forename: S W
authors.initials: SW
authors.lastname: Wiener
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000328:Adult; D002545:Brain Ischemia / Q000139:chemically induced* / Q000473:pathology; D002186:Cannabinoids / Q000008:administration & dosage / Q000633:toxicity*; D006801:Humans; D008297:Male; D020521:Stroke / Q000209:etiology / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications / Q000473:pathology*; D014481:United States
chemical_list: D002186:Cannabinoids; C585106:XLR-11
keywords: Acute kidney injury; Ischemic stroke; JWH-018; Marijuana; Synthetic cannabinoid; XLR-11