Stroke may occur in a person who uses amphetamine, methamphetamine or related drugs.
The frequency and severity of stroke injury may be subject to reporting bias, with minor strokes going unreported.
The occurrence of drug-related stroke is more likely to be suspected in a younger patient but can occur at any age.
Mechanisms may involve:
(1) berry aneurysm with rupture and subarachnoid hemorrhage
(2) arteriovenous malformation with subarachnoid hemorrhage
(3) vasospasm
(4) vasculitis, angiitis, arteritis
(5) emboli
(6) carotid artery dissection
Risk factors:
(1) chronic hypertension
(2) severe acute hypertension
(3) tachycardia
The onset may be within minutes or hours of drug use.
Clinical features may include:
(1) headache
(2) nausea and vomiting
(3) confusion or altered mental status
(4) motor signs
(5) seizures
(6) visual field defect
Hemorrhagic stroke tends to be associated with oral or intravenous routes, while ischemic stroke tends to occur after inhalation.
Factors modifying the course and outcomes:
(1) concurrent drug use (cocaine, other)
(2) trauma
(3) sepsis or endocarditis
(4) HIV-related disease
