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.