Author + information
- Valérie Wolff, MD, PhD∗ (, )
- Ielyzaveta Zinchenko, MD,
- Véronique Quenardelle, MD,
- Olivier Rouyer, MD, PhD and
- Bernard Geny, MD, PhD
- ↵∗Unité neuro-vasculaire, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67 098 Strasbourg, France
Stroke is considered as a leading cause of disability worldwide. Less than 15% of all ischemic stroke (IS) occurs in young adults, but the consequences in this age group are of great concern because of the longer expected survival relative to older patients (1). The recent increased incidence of stroke in the young has partly been related to life-style risk factors (2), and a temporal relationship between cannabis exposure (the most frequently used illicit drug worldwide) and the occurrence of cardiovascular events has been recently reported (3). However, clinical and prognostic characteristics of IS patients who are current cannabis users (CU) and non-cannabis users (NCU) were not analyzed previously.
In the present study, CU and NCU were compared in a prospective series of IS in young adults. The study was conducted over a 9-year period (2005 to 2014) and included all consecutive patients, age <45 years, hospitalized for an acute IS. The use of illicit drug (cannabis, cocaine, and amphetamines) and the protocol of investigations were specifically assessed as described previously (4). Neurological symptoms were reported on admission, and the prognosis was evaluated 3 months after the stroke by the modified Rankin Scale.
All data were compared between CU versus NCU. Continuous data were expressed as mean ± SD and categorical data as the number and the frequency (%). Continuous variables were compared with the Student t test, and categorical data were compared with the chi-square test or with the Fisher exact test. For the Rankin scale, data are expressed as the median/interquartile range, and the Mann-Whitney U test was used because values are not normally distributed. A p value <0.05 was considered as significant.
Of the 334 patients included in the series, 17.4% were CU (n = 58, 2 of them were also cocaine abusers). Characteristics of both CU and NCU are detailed in Table 1. CU were significantly younger, more frequently men, and consumed tobacco and alcohol more frequently than NCU. In CU, the main etiology of the stroke was intracranial arterial stenosis in 45% of cases. At admission, CU displayed a 1-sided motor deficit similarly to NCU; however, CU more frequently displayed visual disorders and less aphasia compared with NCU. Functional independence was similar in both subgroups. Despite a favorable prognosis in both groups, 5 patients died after the stroke.
In addition to representing the most important series of IS patients in CU (58 patients), the current report provides a first-time analysis of the characteristic’s differences between CU and NCU stroke patients. CU patients were younger, more frequently male, and were more frequently exposed to other life-style risk factors relating to the fact that cannabis consumption is frequently associated with tobacco use and to some festive habits in young males (3). The higher prevalence of intracranial arterial stenosis as a cause of IS in CU in our series is in accordance with the potential involved mechanisms of stroke in CU represented by reversible cerebral vasoconstriction, and impairment of cerebral mitochondrial respiration induced by tetrahydrocannabinol (4,5). The reversibility of vasoconstriction was also described in peripheral arteritis associated with cannabis use (3). Our data demonstrate that a favorable functional capacity is common in young patients suffering from stroke independently of cannabis use that is likely due to age-related enhanced brain plasticity. However, in the whole series, 18% of patients retained significant disability, along with 5 deaths.
Fighting stroke must remain a priority, including in young adults. The first step may be to inform the public regarding the potential occurrence of stroke associated with cannabis use and other life-style risk factors (3), particularly nowadays when cannabis use is encouraged by new legislations worldwide.
The authors are grateful to François Piquard, PhD, and Rodrigue Galani, PhD, for performing the statistical analysis.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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