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A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse.

Abstract
Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Several common mechanisms have been identified, such as arrhythmias and cardioembolism, hypoxia, vascular toxicity, vascular spasm and effects on the thrombotic mechanism, as causes for ischemic stroke. For hemorrhagic stroke, acute hypertension, aneurysm formation/rupture and angiitis-like changes have been implicated. In AAS abuse, the effect of blood pressure is rather substance specific, whereas increased erythropoiesis usually leads to thromboembolism. Transient vasospasm, caused by synthetic cannabinoids, could lead to ischemic stroke. Opiates often cause infective endocarditis, resulting in ischemic stroke and hypereosinophilia accompanied by pyogenic arthritis, provoking hemorrhagic stroke. Genetic variants are linked to increased risk for stroke in cocaine abuse. The fact that case reports on cannabis-induced stroke usually refer to the young population is very alarming.
AuthorsAristides Tsatsakis, Anca Oana Docea, Daniela Calina, Konstantinos Tsarouhas, Laura-Maria Zamfira, Radu Mitrut, Javad Sharifi-Rad, Leda Kovatsi, Vasileios Siokas, Efthimios Dardiotis, Nikolaos Drakoulis, George Lazopoulos, Christina Tsitsimpikou, Panayiotis Mitsias, Monica Neagu
JournalJournal of clinical medicine (J Clin Med) Vol. 8 Issue 9 (Aug 23 2019) ISSN: 2077-0383 [Print] Switzerland
PMID31450861 (Publication Type: Journal Article, Review)

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