gms | German Medical Science

Objective: Increasing amphetamine abuse worldwide has aroused widespread concern in medical and governmental agencies. Cerebral angiitis and intracranial hemorrhage are reported to associate with amphetamine abuse. The mortality rate is estimated at 50%. The two major factors involved are the drug hypertensive effect, a preexisting vascular alteration, and a cerebral vasculitis. We report on case of amphetamine-related intracranial hemorrhage and review the current literature.

Methods: A 26-year-old man developed complete loss of consciousness. On admission, he was intubated and ventilated. His vital signs were blood pressure 116/80 mmHg, pulse rate 78/min, respiration rate 14/min. Apart from prothrombin time (68%), laboratory studies showed normal blood count, biochemistry, and platelet count. A toxicology screen test for urine was found to be positive for ecstasy. Computed tomographic scans demonstrated a large intracerebral hemorrhage in the left frontal and parietal lobes as well as intraventricular hemorrhage with induced hydrocephalus. The patient underwent a left frontoparietal craniotomy. Evacuation of the hematoma and insertion of external ventricular drain was performed. One day post-surgery patient was extubated. Attention, concentration, and delayed recall were severely affected. Patient reported a long-term use of crystal and ecstacy. Five days later, patient developed loss of consciousness, he was reintubated and ventilated. MR scans without and with contrast-enhancement showed a brain oedema and sign of cerebral vasculitis. Intracranial pressure (ICP) monitoring showed >20 mmHg. CT scans demonstrated malignant space-occupying supratentorial brain oedema. He died 48 hours later.

Results: The rate of strokes among amphetamine and amphetamine abusers is increasing. The exact mechanism remains unclear. Many factors could be involved including vasospasm, cerebral vasculitis, enhanced platelet aggregation, cardioembolism, and hypertensive surges. Around 40% of patients have preexisting vascular lesions. Cerebral angiographic or MRA examination is recommended in cases of amphetamin-related intracerebral hemorrhage, especially if the hemorrhage is lobar or intraventricular.

Conclusions: A detailed history focusing on the use of illicit substances and toxicological screening of urine and serum should be added to the evaluation of any young patient with intracerebral hemorrhage.