jwh-018 and Brain-Ischemia

To report and associate acute cerebral infarctions in 2 young, previously healthy siblings with use of the street drug known as "spice" (a synthetic marijuana product, also known as "K2"), which they independently smoked before experiencing acute embolic-appearing ischemic strokes.. We present history, physical examination, laboratory data, cerebrovascular imaging, echocardiogram, ECG, and hospital course of these patients.. We found that in both siblings spice was obtained from the same source. The drug was found to contain the schedule I synthetic cannabinoid JWH-018. Full stroke workup was unrevealing of a stroke etiology; urine drug screen was positive for marijuana.. We found that our 2 patients who smoked the street drug spice had a temporal association with symptoms of acute cerebral infarction. This association may be confounded by contaminants in the product consumed (i.e., marijuana or an unidentified toxin) or by an unknown genetic mechanism. The imaging of both patients suggests an embolic etiology, which is consistent with reports of serious adverse cardiac events with spice use, including tachyarrhythmias and myocardial infarctions.

Topics: Adult; Brain Ischemia; Female; Humans; Illicit Drugs; Indoles; Male; Marijuana Smoking; Naphthalenes; Stroke; Young Adult

The endocannabinoid system includes 2 types of G-protein coupled receptors: CB1 (mostly in the brain) and CB2 (in peripheral lymphoid tissue). The major cannabinoid ligands are arachidonylethanolamine ("anandamide," the Sanskrit word for bliss) and 2-arachidonylglycerol ("2AG"). It is by binding to CB1 receptors that δ-9-tetrahydrocannabinol (THC), the principal psychoactive ingredient in marijuana ("pot"), produces its intended subjective effects.

Topics: Brain Ischemia; Female; Humans; Illicit Drugs; Indoles; Male; Marijuana Smoking; Naphthalenes; Stroke