Its current popularity is declining: the number of new users dropped from 958,000 in 2000 to 337,000
in 2009 (Mechem and Hall 2008; Substance Abuse and Mental Health Services Administration 2010). LSD and Stroke Only four cases of stroke related to LSD have been reported in the literature. All of the cases involved AIS in selleck screening library patients under the age of 25 (Sobel et al. 1971; Lieberman et al. 1974). The two cases in which LSD was the sole drug used by the patients were cases that involved large-artery occlusions. Similar to ergot alkaloids, LSD affects serotonin receptors and may cause vessel constriction. In vitro, LSD produces significant vasospasm of cerebral arteries; this Inhibitors,research,lifescience,medical effect is reversed by a 5-HT antagonist (methysergide) or a calcium channel blocker (verapamil) (Altura and Altura 1981). Given the apparent ability of LSD to cause vasospasm in vitro, it is more likely that a vasospastic process is Inhibitors,research,lifescience,medical responsible for LSD-related strokes (Altura and Altura 1981). Marijuana Marijuana is the most commonly used recreational drug in the United States, and 15 states have approved marijuana for medical
use (State Medical Marijuana Laws 2010). More than 16.7 million people reported marijuana use within the past month on a national survey conducted in 2009 Inhibitors,research,lifescience,medical (Substance Abuse and Mental Health Services Administration 2010). Marijuana and Stroke Evidence supporting Inhibitors,research,lifescience,medical marijuana’s role in stroke is scarce, considering its widespread use. One study demonstrated
an odds ratio for AIS with marijuana use of 1.76 (95% confidence interval 1.15–2.71), even when controlling for other risk factors (Kaku and Lowenstein 1990). Twenty-one cases of imaging-positive stroke related to marijuana use have been reported (Cooles and Michaud 1987; Zachariah 1991; Barnes et al. 1992; Lawson and Rees 1996; McCarron and Thomas 1997; Mouzak et al. 2000; Mesec et al. 2001; Mathew et al. 2003; Finsterer et al. 2004; Geller et Inhibitors,research,lifescience,medical al. 2004; Moussouttas 2004; Mateo et al. 2005; Aryana and Williams 2007; Duchene et al. 2010; Renard et al. 2010). Twenty were ischemic infarcts in men; one was an ischemic infarct in a woman (Duchene et al. 2010). No consistent pattern of infarct distribution medroxyprogesterone was identified. Proposed mechanisms for marijuana-associated cerebral infarction include hypotension, vasospasm, and arrhythmia with resulting cardioembolism (Cooles and Michaud 1987; Mathew et al. 2003; Geller et al. 2004; Moussouttas 2004; Mateo et al. 2005; Aryana and Williams 2007). Since these phenomena are often transient, the direct role in stroke is elusive. Cannabinoids have a role in cerebral autoregulation, vascular tone, and cardiac pathology (Mittleman et al. 2001; Mathew et al. 2003; Moussouttas 2004) and may provoke the reversible vasoconstriction syndrome associated with thunderclap headache, SAH, ICH, and cerebral ischemia (Ducros et al. 2007).