humulene and Constriction--Pathologic

Leading aetiologies of ischaemic stroke in young adults are cervico-cerebral arterial dissections and cardio-embolism, but the causes remain undetermined in a considerable proportion of cases. In a few reports, intracranial arterial stenosis has been suggested to be a potential cause of ischaemic stroke in young adults. The aim of our work was to evaluate the frequency, characteristics and risk factors of intracranial arterial stenosis in a prospective series of young ischaemic stroke patients.. The study was based on a prospective consecutive hospital-based series of 159 patients aged 18-45 years who were admitted to our unit for an acute ischaemic stroke from October 2005 to December 2010. A structured questionnaire was used in order to assess common vascular risk factors such as hypertension, diabetes, hypercholesterolemia, use of tobacco, alcohol and illicit drugs, migraine, and, in women, oral contraceptive use. A systematic screening was performed, including the following: brain magnetic resonance imaging or, if not feasible, brain computed tomography scan, carotid and vertebral Duplex scanning and trans-cranial Doppler sonography, 3D time-of-flight magnetic resonance cerebral angiography or cerebral computed tomography angiography. Long-duration electrocardiography, trans-thoracic and trans-oesophageal echocardiography were performed and laboratory blood investigations were extensive. Urine samples were screened for cannabinoids, cocaine, amphetamine and methylene-dioxy-methamphetamine. When this initial work-up was inconclusive, trans-femoral intra-arterial selective digital subtraction angiography with reconstructed 3D images was performed.. In this series, 49 patients (31%) had intracranial arterial stenosis. Other defined causes were found in 91 patients (57%), including cardio-embolism in 32 (20%), cervical dissection in 23 (14%), extracranial atherosclerosis in 7 (4%), haematological disorders in 7 (4%), small vessel disease in 1, and isolated patent foramen ovale in 21 (13%); in 19 patients (12%), ischaemic stroke was related to an undetermined aetiology. Comparing risk factors between patients with intracranial arterial stenosis and those with other definite causes showed that there were only two significant differences: a lower age and a higher frequency of vasoactive substances (especially cannabis) in patients with intracranial arterial stenosis. All intracranial arterial stenosis in patients who used vasoactive substances were located in several intracranial vessels.. Intracranial arterial stenosis may be an important mechanism of stroke in young patients and it should be systematically investigated using vascular imaging. Strong questioning about illicit drug consumption (including cannabis) or vasoactive medication use should also be performed. It should be emphasized for health prevention in young adults that cannabis use might be associated with critical consequences such as stroke.

Topics: Adolescent; Adult; Brain Ischemia; Cannabis; Cerebral Angiography; Cerebral Arteries; Constriction, Pathologic; Female; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Prospective Studies; Risk Factors; Stroke; Young Adult

Thunderclap headache may be a symptom of a severe underlying disorder.. A 41-year-old man had recurrent episodes of thunderclap headache triggered by Valsalva-like manoeuvres. His medical history reported cannabis exposure. Angiography showed segmental vasoconstriction of cerebral arteries. He stopped using cannabis and tried to avoid intracranial pressure increasing activities. 3 months later he was no longer experiencing any symptoms and the vascular anomalies had clearly improved. We concluded that reversible cerebral vasoconstriction syndrome (RCVS) was the underlying cause of the thunderclap headache.. In contrast with primary thunderclap headache and primary headache due to sex, cough and exertion, RCVS is not harmless, since the characteristic cerebral vasoconstriction can lead to life-threatening neurologic complications. The increasing quality of diagnostic imaging techniques will probably lead to such primary headaches being diagnosed less frequently and, more specifically, to more frequent diagnosis of severe underlying pathology. Because of the differences in prognosis and treatment, proper diagnostic imaging should be performed in all patients with thunderclap headache.

Topics: Adult; Cannabis; Cerebral Angiography; Cerebral Arteries; Constriction, Pathologic; Headache; Humans; Male

A 35-year-old woman was hospitalized for subacute ischemia of the left leg following an intermittent claudication for some weeks. She also presented paleness and coldness of both hands. The radial pulses could not be palpated. Smoking was the only cardiovascular risk factor. Duplex ultrasonography and angiography revealed a left popliteal thrombus combined with low diameter leg arteries and in the upper limbs stenosis of the left radial artery and thrombosis of the right radial artery. Search for a metabolic, embolic or thrombophilic etiology was negative. More minute history taking revealed use of cannabis and recent nasal administration of cocaine. Her condition improved with heparin therapy except for the upper limbs with ischemia of the hands and disabling Raynaud's phenomenon. This report highlights the combined arterial toxicity of drugs often used together by drug addicts. The association of cannabis use and tobacco smoking is not rare in patients with Buerger-like juvenile arteriopathy and cocaine may provoke peripheral vascular disease by embolism or in situ thrombosis. Interrogation of a patient presenting with Buerger-like peripheral arterial disease should insist on detecting use of drugs in association with tobacco smoking.

Topics: Adult; Cannabis; Cocaine; Constriction, Pathologic; Female; Hand; Heparin; Humans; Ischemia; Leg; Popliteal Artery; Radial Artery; Raynaud Disease; Smoking; Thrombosis; Vascular Diseases