Article
Cerebrovascular complications due to chronic drug abuse-from ICH to CVT
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Authors
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Michéle Simon
- Neurochirurgische Klinik, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Deutschland
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Rupert Reichart
- Neurochirurgische Klinik, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Deutschland
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Rolf Kalff
- Neurochirurgische Klinik, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Deutschland
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Jan Walter
- Neurochirurgische Klinik, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Deutschland
| Published: | June 2, 2015 |
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Outline
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Objective: Chronic drug abuse is a diverse problem, involving multiple drugs and various rates of abuse. Sympathomimetic drugs (cocaine, met-/amphetamines, ecstasy) share mechanisms of activating the adrenergic nervous system. This effect may result in diverse severe cerebrovascular complications like hemorrhagic and also ischemic strokes as well as more generalized thrombotic events like cerebral venous sinus thrombosis. Further, toxic leucoencephalopathy is a rare but life-threatening complication of heroin abuse.
Method: We report a current series of various severe cerebrovascular events in young patients due to chronic drug abuse and try to elucidate the underlying pathophysiological mechanisms.
Results: #1: A 28-year-old female with initial tonic clonic seizures presented with a right sided intracranial hemorrhage (ICH), eading to transtentorial herniation. Toxicology was positive for met-/amphetamines, benzodiazepines and cannabinoids. MRI/MRA revealed no evidence of vascular malformation or vasculitis. ICHs are a known complication of amphetamine abuse, caused by severe transient elevations in blood pressure. Especially methamphetamines can cause vasculitis, another potential cause of spontaneous ICH.
#2: A 29-year-old female with a known abuse of Crystal (methamphetamine) was found in an unconscious status (GCS 8). MRV finally revealed an extensive thrombosis of cerebral veins and sinus (CVT). Progressive edema and herniation made bilateral decompression necessary. Common risk factors for CVT could be ruled out. Besides a possible methamphetamine-related cerebral vasculitis, a status of drug induced hypercoagulability combined with hypovolemia induced increase in blood viscosity are hypothetical causes of this CVT.
#3: A 38-year-old male was found comatose. MRI showed bilateral supra- but also infratentorial hyperintense white matter lesions on T2WI, FLAIR and DWI. ADC values were elevated indicating vasogenic edema, which was resistant to any conservative treatment and made infratentorial decompression necessary. Toxicology was positive for heroin and lidocaine. Toxic leucoencephalopathy is a rare complication of heroin abuse and may turn life-threatening when infratentorial structures are involved
Conclusions: In light of an increasing abuse of Crystal Meth in Germany chronic drug consumption may lead to devastating cerebral and cerebrovascular complications. Therefore, drug misuse should be considered in cases of unclear hemorrhagic or ischemic strokes, cerebral venous thrombosis and even leucoencephalopathy.
