Wednesday, July 4, 2012

Substance Abuse and Stroke

            Many commonly abused drugs can cause strokes.  The only way to avoid this risk is by not taking them.

OPIATES      
Opiates are narcotics. Their risk of causing stroke occurs mostly with intravenous use.  They include heroin, morphine, Demerol (meperidine), and Dilaudid (hydromorphone).  When oral narcotics are ground up and injected the risk is increased due to small solid particles that are injected.

Endocarditis
Intravenous injection of drugs can cause bacteria to be injected along with the drug.  This can cause endocarditis, an infection inside the heart.  Infected blood clots form and break off as emboli, which are pieces of clots floating in the bloodstream.  These can travel to arteries in the brain and block them.  The clots can cause ischemic stroke when the brain tissue has no blood and is killed.  The clots can also cause hemorrhagic stroke when the arteries damaged by the clots break open and bleed into the brain.  Because these clots are infected they can cause brain abscesses, which are infections that cause cavities with collections of pus in the brain.

Liver and Kidney Damage
Heroin users may have hemorrhagic strokes if they develop hepatitis (such as hepatitis B from the injection with a needle that has hepatitis virus in it), liver failure and loss of blood clotting factors made by the liver. They may hemorrhagic strokes if they develop heroin nephropathy in which the heroin damages the kidneys causing uremia (kidney failure) or high blood pressure from kidney damage.

Vasculitis
This is an inflammation of larger arteries that can be caused by intravenous drug use. The arteries become blocked by the inflammation and the blood flow is cut off.

Diffuse angiitis
This is an inflammation of the smaller arteries.

Emboli from Particles
Emboli from talc or adulterants of injected drugs: Particles of talc, other contaminants, or undissolved particles from tablets that are ground up to inject can act like blood clots and block arteries and cause strokes.

AMPHETAMINE AND RELATED AGENTS

Acute intoxication
Acute drug intoxication causes excitement, high blood pressure, fever, coma, vascular collapse (failure of the circulatory system), and death.

Necrotizing Angiitis
This is associated with methamphetamine, usually intravenous.  It is an inflammation of the wall of arteries and can cause scarring and obstruction of the artery. It also can cause necrosis of the artery. The tissue of the arterial wall dies and the artery breaks open.  This can result in ischemic stroke (blocked arteries and death of brain tissue) or hemorrhagic stroke (bleeding into the brain).  Arteries can affected anywhere in the body.

COCAINE
Cocaine may cause ischemic or hemorrhagic stroke.  It can cause vasospasm (spasm of the arteries) or vasculitis (inflammation of the arteries).  Cocaine can cause the same problems in the coronary arteries (the arteries that supply blood to the heart muscle) and can cause a heart attack.  Ingestion of alcohol with cocaine results in metabolism (conversion) of cocaine to cocaethylene, which is more potent than cocaine.  Cocaine use during pregnancy may cause neonatal stroke (stroke in the newborn baby) and possibly brain malformations.

PHENCYCLIDINE (PCP)
PCP causes high blood pressure both early and late after ingestion.  PCP causes constriction of blood vessels in the brain.  Because PCP is stored in fat, people have recurring episodes of PCP intoxication when it is release from the fat.

LSD
LSD causes hypertension and vasospasm.  Vascular occlusion (blocked arteries) and stroke have been reported to occur.

MARIJUANA
Delta-9-tetrahydrocannabinol is the active ingredient of marijuana.  It has a vasoconstrictor effect in animal studies.  Proposed mechanisms for causing stroke include cerebral vasospasm (spasm of arteries in the brain). Marijuana is also associated with widespread narrowing of arteries in the brain.

INHALANTS
Sniffing glue or toluene may cause stroke, vasospasm (constriction of arteries), or cardiac arrhythmia (an irregular heart rhythm that can cause a blood clot leading to a stroke).

References

CONTINUUM.  Acute Stroke Management.  Volume 9.  Number 2.  April, 2003.

Mohr JP, Choi DW, Grotta JC, Weir B, Wolf PA.  Stroke: Pathophysiology, Diagnosis, and Management.  4th Ed.  Churchill Livingstone, 2004.

Copyright 2012 Neurology Associates of Arlington, P.A.

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