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Humayun M, Suarez JI, Shah VA. Neurological Complications of Cannabinoids. Semin Neurol 2024; 44:430-440. [PMID: 38914126 DOI: 10.1055/s-0044-1787570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications.
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Affiliation(s)
- Mariyam Humayun
- Department of Neurology, University of Illinois, Chicago, Illinois
| | - Jose I Suarez
- Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vishank A Shah
- Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Guo Y, Wei X, Pei J, Yang H, Zheng XL. Dissecting the role of cannabinoids in vascular health and disease. J Cell Physiol 2024:e31373. [PMID: 38988064 DOI: 10.1002/jcp.31373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/04/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
Cannabis, often recognized as the most widely used illegal psychoactive substance globally, has seen a shift in its legal status in several countries and regions for both recreational and medicinal uses. This change has brought to light new evidence linking cannabis consumption to various vascular conditions. Specifically, there is an association between cannabis use and atherosclerosis, along with conditions such as arteritis, reversible vasospasm, and incidents of aortic aneurysm or dissection. Recent research has started to reveal the mechanisms connecting cannabinoid compounds to atherosclerosis development. It is well known that the primary biological roles of cannabinoids operate through the activation of cannabinoid receptor types 1 and 2. Manipulation of the endocannabinoid system, either genetically or pharmacologically, is emerging as a promising approach to address metabolic dysfunctions related to obesity. Additionally, numerous studies have demonstrated the vasorelaxant properties and potential atheroprotective benefits of cannabinoids. In preclinical trials, cannabidiol is being explored as a treatment option for monocrotaline-induced pulmonary arterial hypertension. Although existing literature suggests a direct role of cannabinoids in the pathogenesis of atherosclerosis, the correlation between cannabinoids and other vascular diseases was only reported in some case series or observational studies, and its role and precise mechanisms remain unclear. Therefore, it is necessary to summarize and update previously published studies. This review article aims to summarize the latest clinical and experimental research findings on the relationship between cannabis use and vascular diseases. It also seeks to shed light on the potential mechanisms underlying these associations, offering a comprehensive view of current knowledge in this evolving field of study.
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Affiliation(s)
- Yanan Guo
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Biochemistry and Molecular Biology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xiaoyun Wei
- Department of Cardiology, The Fifth School of Clinical Medicine of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junyu Pei
- Department of Biochemistry and Molecular Biology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Haibo Yang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi-Long Zheng
- Department of Biochemistry and Molecular Biology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Echeverria-Villalobos M, Guevara Y, Mitchell J, Ryskamp D, Conner J, Bush M, Periel L, Uribe A, Weaver TE. Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution. Front Cardiovasc Med 2024; 11:1343549. [PMID: 38978789 PMCID: PMC11228818 DOI: 10.3389/fcvm.2024.1343549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
Background Cannabis is one of the most widely used psychoactive substances. Its components act through several pathways, producing a myriad of side effects, of which cardiovascular events are the most life-threatening. However, only a limited number of studies address cannabis's perioperative impact on patients during noncardiac surgery. Methods Studies were identified by searching the PubMed, Medline, EMBASE, and Google Scholar databases using relevant keyword combinations pertinent to the topic. Results Current evidence shows that cannabis use may cause several cardiovascular events, including abnormalities in cardiac rhythm, myocardial infarction, heart failure, and cerebrovascular events. Additionally, cannabis interacts with anticoagulants and antiplatelet agents, decreasing their efficacy. Finally, the interplay of cannabis with inhalational and intravenous anesthetic agents may lead to adverse perioperative cardiovascular outcomes. Conclusions The use of cannabis can trigger cardiovascular events that may depend on factors such as the duration of consumption, the route of administration of the drug, and the dose consumed, which places these patients at risk of drug-drug interactions with anesthetic agents. However, large prospective randomized clinical trials are needed to further elucidate gaps in the body of knowledge regarding which patient population has a greater risk of perioperative complications after cannabis consumption.
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Affiliation(s)
| | - Yosira Guevara
- Department of Anesthesiology, St Elizabeth’s Medical Center, Brighton, MA, United States
| | - Justin Mitchell
- Department of Anesthesiology & Perioperative Medicine, UCLA Medical Center, Los Angeles, CA, United States
| | - David Ryskamp
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joshua Conner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margo Bush
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
| | - Luis Periel
- Touro College of Osteopathic Medicine, New York, NW, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Carter C, Laviolette L, Bietar B, Zhou J, Lehmann C. Cannabis, Cannabinoids, and Stroke: Increased Risk or Potential for Protection-A Narrative Review. Curr Issues Mol Biol 2024; 46:3122-3133. [PMID: 38666926 PMCID: PMC11048784 DOI: 10.3390/cimb46040196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Worldwide, approximately 15 million people per year suffer from stroke. With about 5 million deaths, stroke is the second most common cause of death and a major cause of long-term disability. It is estimated that about 25% of people older than 85 years will develop stroke. Cannabis sativa and derived cannabinoids have been used for recreational and medical purposes for many centuries. However, due to the legal status in the past, research faced restrictions, and cannabis use was stigmatized for potential negative impacts on health. With the changes in legal status in many countries of the world, cannabis and cannabis-derived substances such as cannabinoids and terpenes have gained more interest in medical research. Several medical effects of cannabis have been scientifically proven, and potential risks identified. In the context of stroke, the role of cannabis is controversial. The negative impact of cannabis use on stroke has been reported through case reports and population-based studies. However, potential beneficial effects of specific cannabinoids are described in animal studies under certain conditions. In this narrative review, the existing body of evidence regarding the negative and positive impacts of cannabis use prior to stroke will be critically appraised.
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Affiliation(s)
| | | | | | | | - Christian Lehmann
- Department of Anesthesia, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.C.); (L.L.); (B.B.); (J.Z.)
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Lo BD, Chen SY, Stem M, Papanikolaou A, Gabre-Kidan A, Safar B, Efron JE, Atallah C. Prevalence of cannabis use disorder and perioperative outcomes in adult colectomy patients: A propensity score-matched analysis. World J Surg 2024; 48:701-712. [PMID: 38342773 DOI: 10.1002/wjs.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of postoperative complications among adult colectomy patients. METHODS Adult patients undergoing an elective colectomy were retrospectively analyzed from the National Inpatient Sample database (2004-2018). To control for potential confounders, patients with CUD, defined using ICD-9/10 codes, were propensity score matched to patients without CUD in a 1:1 ratio. The association between preoperative CUD and composite morbidity, the primary outcome of interest, was assessed. Subgroup analyses were performed after stratification by age (≥50 years). RESULTS Among 432,018 adult colectomy patients, 816 (0.19%) reported preoperative CUD. The prevalence of CUD increased nearly three-fold during the study period from 0.8/1000 patients in 2004 to 2.0/1000 patients in 2018 (P-trend<0.001). After propensity score matching, patients with CUD exhibited similar rates of composite morbidity (140 of 816; 17.2%) as those without CUD (151 of 816; 18.5%) (p = 0.477). Patients with CUD also had similar anastomotic leak rates (CUD: 5.64% vs. No CUD: 6.25%; p = 0.601), hospital lengths of stay (CUD: 5 days, IQR 4-7 vs. No CUD: 5 days, IQR 4-7) (p = 0.415), and hospital charges as those without CUD. Similar findings were seen among patients aged ≥50 years in the subgroup analysis. CONCLUSIONS Though the prevalence of CUD has increased drastically over the past 15 years, preoperative CUD was not associated with an increased risk of composite morbidity among adult patients undergoing an elective colectomy.
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Affiliation(s)
- Brian D Lo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Y Chen
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angelos Papanikolaou
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alodia Gabre-Kidan
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bashar Safar
- Division of Colon and Rectal Surgery, Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chady Atallah
- Division of Colon and Rectal Surgery, Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
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Desai R, Brereton B, Patta HVC, Bansal P, Jain A, Vyas A. Prevalence and impact of cannabis use disorder on acute ischemic stroke and subsequent mortality in elderly peripheral vascular disease patients: A population-based analysis in the USA (2016 - 2019). Curr Probl Cardiol 2024; 49:102162. [PMID: 37871709 DOI: 10.1016/j.cpcardiol.2023.102162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Given current evidence linking peripheral atherosclerotic disease, also known as cannabis arteritis, and acute ischemic stroke (AIS) in individuals with cannabis use disorder (CUD), we investigated the frequency and implications of CUD in relation to AIS risk and outcomes among elderly patients with peripheral vascular disease (PVD). METHODS The National Inpatient Sample (2016-2019) was used to compare geriatric patients with PVD and cannabis use disorder CUD. CUD was correlated with AIS admissions. Adjusted multivariable regression models assessed in-hospital mortality rates. RESULTS Of 5,115,824 geriatric admissions with PVD, 50.6 % were male and 77.5 % were white. 21,405 admissions had cardiovascular and CUD co-occurrence. 19.7 % of CUD patients had diabetes mellitus (DM), compared to 33.7 % of non-CUD patients. Smoking and HTN rates were comparable between groups. Patients with CUD used more recreational drugs concurrently than those without CUD. AIS prevalence was 5.2 % in CUD patients and 4.0 % in controls (p < 0.001). In the geriatric population with PVD, the presence of CUD was found to be associated with increased odds of hospitalizations due to AIS, with an adjusted odds ratio (aOR) of 1.34 (95 % confidence interval [CI] 1.18-1.52, p < 0.001). All-cause in-hospital mortality was not statistically significant, with an aOR of 0.71 (95 %CI 0.36-1.37, p = 0.302). In our study, older patients with PVD and hypertension (aOR 1.73) had a greater risk of AIS. Intriguingly, when we analyzed AIS predictors in elderly PVD patients with concurrent tobacco use disorder, we identified a counterintuitive protective effect (aOR 0.58, 95 % CI 0.42-0.79, p < 0.001). CONCLUSIONS Our findings indicate that among geriatric patients with PVD and concurrent CUD, there is a notable 34 % risk of AIS. Importantly, this risk persists despite controlling for other CVD risk factors and substance use. Further investigations are warranted to elucidate and validate the intriguing phenomenon known as the smoker's paradox.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, St. Helier, Jersey
| | | | - Prerna Bansal
- Department of Medicine, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Akhil Jain
- Division of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ankit Vyas
- Division of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
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Clement A, Pezel T, Lequipar A, Guiraud-Chaumeil P, Singh M, Poinsignon H, El Beze N, Gall E, Goncalves T, Lafont A, Henry P, Dillinger JG. [Recreative drug use and cardiovascular disease]. Ann Cardiol Angeiol (Paris) 2023; 72:101638. [PMID: 37738755 DOI: 10.1016/j.ancard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/24/2023]
Abstract
Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.
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Affiliation(s)
- Arthur Clement
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Theo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Paul Guiraud-Chaumeil
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Manveer Singh
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Hugo Poinsignon
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Nathan El Beze
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Trecy Goncalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France.
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Eski MT, Teberik K, Taha S, Büken B, Turan Sönmez F. Compare of optic coherence tomography parameters in recreational synthetic tetrahydrocannabinol use and healthy control. Cutan Ocul Toxicol 2023; 42:179-183. [PMID: 37417942 DOI: 10.1080/15569527.2023.2234042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To evaluate retinal thickness (RT), retinal nerve fiber layer thickness (RNFLT), and choroidal thickness (CT) changes in synthetic cannabinoid (SC) users. METHODS This prospective study evaluated the RT, RNFLT, and CT values of 56 SC users and 58 healthy controls. The individuals using SCs were referred to us by our hospital's forensic medicine department. Retinal and choroidal images were obtained using spectral-domain optical coherence tomography (OCT). Measurements (one subfoveal, three temporals, three nasal) were taken at 500 μm intervals up to 1500 μm using the caliper system. Only the right eye was used for subsequent analysis. RESULTS Mean ages were 27.7 ± 5.7 years in the SC-user group and 25.4 ± 6.7 in the control group. Subfoveal Global RNFLT was in the SCs group 102.3 ± 10.5 μm and 105.6 ± 20.2 μm in the control group (p = 0.271). Subfoveal CT was in the SC group mean of 316.1 ± 100.2 μm and in the control group mean 346.4 ± 81.8 μm (p = 0.065). RT, T500 (283.3 ± 36.7 μm, 296.6 ± 20.5 μm, p = 0.011) and N1500 (355.1 ± 14.3 μm, 349.3 ± 18.1 μm, p = 0.049) were significantly higher in the SC group than in the control group, respectively. CONCLUSION Analysis of OCT findings of individuals who had been using SC for more than one year revealed no statistically significant difference between RNFLT and CT, although N1500 was significantly higher in RT. Further studies in the field of OCT are important to explore the pathology of SC.
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Affiliation(s)
- Mehmet Tahir Eski
- Department of Ophthalmology, Erzincan Private Neon Hospital, Erzincan, Turkey
| | - Kuddusi Teberik
- Department of Ophthalmology, Duzce University School of Medicine, Duzce, Turkey
| | - Sezer Taha
- Department of Ophthalmology, Duzce University School of Medicine, Duzce, Turkey
| | - Bora Büken
- Department of Forensic Medicine, Duzce University
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Abstract
OBJECTIVE This article informs and updates the practicing neurologist on the current landscape of known neurologic injuries linked to the use of illicit drugs, focusing on emerging agents. LATEST DEVELOPMENTS Synthetic opioids such as fentanyl and similar derivatives have exploded in prevalence, becoming the leading cause of overdose fatalities. The higher potency of synthetic opioids compared with semisynthetic and nonsynthetic opiates poses an increased risk for unintentional overdose when found as an adulterant in other illicit drug supplies such as heroin. Conversely, misinformation about the risk of symptomatic exposure to fentanyl through casual contact with the skin and ambient air has led to misdirected fear and stigma that threatens to impede valid harm-reduction measures for fentanyl users at risk of actual overdose. Finally, during the COVID-19 pandemic, overdose rates and deaths continued to climb, especially among those who use opioids and methamphetamine. ESSENTIAL POINTS A variety of potential neurologic effects and injuries can occur with illicit drug use owing to the diverse properties and mechanisms of action of the various classes. Many high-risk agents are not detected on standard drug screens, including so-called designer drugs, and the practicing neurologist is best served by recognizing the clinical features of the traditional toxidrome and other potential idiosyncratic effects of various illicit agents.
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Stroke in Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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RCVS: by clinicians for clinicians-a narrative review. J Neurol 2023; 270:673-688. [PMID: 36305970 PMCID: PMC9615630 DOI: 10.1007/s00415-022-11425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Reversible cerebral vasoconstriction syndrome may be underdiagnosed. It can be accompanied by various complications, mainly intracerebral hemorrhage and ischemic stroke. The clinical presentation of this condition varies according to its localization. The aims of this review are to raise awareness of the disease, especially in the presence of corresponding risk factors; to connect its precipitating factors, pathophysiology, and complications; and to compare various differential diagnoses of vasoconstriction. METHODS A review of the literature in PubMed/MEDLINE and Google Scholar was conducted from May 1997 until May 2022. RESULTS Reversible cerebral vasoconstriction syndrome, which is a clinical-radiological syndrome, is mainly characterized by the occurrence of thunderclap headache and widespread vasoconstriction. The most common precipitating factors are the use of vasoactive substances and postpartum status. The pathophysiology is currently assumed to include two mechanisms: sympathetic overactivity and endothelial dysfunction. From these mechanisms, it is possible to derive potential complications as well as the most important differential diagnoses: posterior reversible encephalopathy syndrome, convexity subarachnoid hemorrhage, ischemic and hemorrhagic stroke, and primary angiitis of the central nervous system. CONCLUSION In general, the outcome of reversible cerebral vasoconstriction syndrome is very good. Vasospasm as well as thunderclap headache attacks can be fully reversible, and > 90% of patients are functionally independent at discharge.
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Desai R, Jain A, Sultan W, Gandhi Z, Raju AR, Varughese VJ, Jnaneswaran G, Agarwal C, Rizvi B, Mansuri Z, Gupta P, Kumar G, Sachdeva R. Hypertensive Crisis-Related Hospitalizations and Subsequent Major Adverse Cardiac Events in Young Adults with Cannabis Use Disorder: A Nationwide Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101465. [PMID: 36295625 PMCID: PMC9609556 DOI: 10.3390/medicina58101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18−44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015−December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06−1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01−1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55−12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38−2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02−2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, USA
- Correspondence: or
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA 19153, USA
| | - Waleed Sultan
- Department of Family Medicine, Conemaugh Memorial Medical Center, Johnstown, PA 15905, USA
| | - Zainab Gandhi
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, USA
| | - Athul Raj Raju
- Department of Medicine, Karuna Medical College, Chittur-Thathamangalam 678103, Kerala, India
| | - Vivek Joseph Varughese
- Department of Internal Medicine, Government Medical College, Thiruvananthapuram 695011, Kerala, India
| | - Geethu Jnaneswaran
- Department of Medicine, SUT Academy of Medical Sciences, Thiruvananthapuram 695028, Kerala, India
| | - Charu Agarwal
- Department of Medicine, Sri Siddhartha Medical College, Tumakuru 572107, Karnataka, India
| | - Bisharah Rizvi
- Department of Internal Medicine, Saint Agnes Medical Center, Fresno, CA 93720, USA
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Puneet Gupta
- Department of Cardiology, Baptist Health Deaconess Madisonville, Madisonville, KY 42431, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, USA
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Chen M, Lu YL, Chen XF, Wang Z, Ma L. Association of cannabis use disorder with cardiovascular diseases: A two-sample Mendelian randomization study. Front Cardiovasc Med 2022; 9:966707. [PMID: 36277767 PMCID: PMC9582269 DOI: 10.3389/fcvm.2022.966707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of cannabis has increased globally due to more regions decriminalizing marijuana use for therapeutic and recreational aims. Several observational studies have revealed that cannabis use is associated with an increased risk of adverse cardiovascular pathologies and diseases. Nevertheless, the causal associations between cannabis use and cardiovascular diseases remain unclear. Hence, we performed single-variable and multivariable Mendelian randomization (MR) to evaluate the association between cannabis use disorder and various cardiovascular diseases. Materials and methods Summary statistics were collected from the largest-to-date genome-wide association studies (GWAS) of cannabis use disorder. The 12 SNPs for cannabis use disorder were used as instrumental variables in this study. MR estimates were pooled using a random-effects inverse-variance weighted (IVW) method. Simple median and weighted median methods were conducted as sensitivity analyses. Results The genetic liability to cannabis use disorder was associated with an augmented risk of coronary artery disease, myocardial infarction, atrial fibrillation, heart failure, deep venous thrombosis, pulmonary embolism, and stroke. Except for stroke, the results were inconsistent in the sensitivity analyses. The overall patterns for the associations of cannabis use disorder with atrial fibrillation, heart failure, pulmonary embolism and stroke remained in multivariable MR analyses adjusting for potential mediators, including smoking, alcohol, body mass index, blood lipid, type 2 diabetes, hypertension, and depression. However, the association with coronary artery disease, myocardial infarction, and deep venous thrombosis did not persist in multivariable MR analyses. Mediation analysis demonstrated that smoking, body mass index, low-density lipoprotein, hypertension, and depression have more significant mediation effects, which suggests that these factors partly mediate the link from cannabis use disorder to coronary artery disease, myocardial infarction, and deep venous thrombosis. Conclusion The genetic liability to cannabis use disorder was associated with a higher risk of atrial fibrillation, heart failure, pulmonary embolism, and stroke. The evidence for the association between cannabis use disorder, coronary artery disease, myocardial infarction, and deep venous thrombosis was weak. Hence, future use of cannabis for therapeutic and recreational aims should consider its potential impact on cardiovascular diseases.
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Affiliation(s)
- Miao Chen
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yun-long Lu
- Department of Cardiology, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiao-fan Chen
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhen Wang
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China,*Correspondence: Zhen Wang,
| | - Liang Ma
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China,Liang Ma,
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Shehata I, Hashim A, Elsaeidy A, Nair A, Urits I, Viswanath O, Kaye A, Habib M. Cannabinoids and Their Role in Chronic Pain Treatment: Current Concepts and a Comprehensive Review. Health Psychol Res 2022; 10:35848. [PMID: 36628124 PMCID: PMC9820704 DOI: 10.52965/001c.35848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
For decades, chronic pain was managed with an almost conventional approach of using a wide range of analgesic spectrum, surgical approaches and complex interventional pain techniques to modulate or even interrupt pain pathways. These different approaches carry many pharmacological hazards together with the lack of efficacy and safety of many interventional and surgical management techniques for chronic pain have mandated searching for other effective therapies including alternative treatments. Cannabinoids are naturally occurring substances that are derived from Cannabis sativa L. The usage of cannabinoids and their related synthetic chemical compounds has emerged as a choice in the management of different chronic pain conditions is being evaluated, however, the efficacy is still not consistently established. In the present investigation, therefore, we discuss the different aspects related to cannabinoids and their implications in the management of chronic pain conditions. This review will also discuss the safety profile of the cannabinoids together with the legal considerations that hinder their use in different countries.
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Affiliation(s)
| | | | | | | | - Ivan Urits
- Louisiana State University Health Sciences Center
| | | | - Alan Kaye
- Louisiana State University Health Sciences Center
| | - Marian Habib
- Hurghada General Hospital, Department of Cardiology, Hurghada, Egypt
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Computed Tomography Angiography Quantification of Intracranial and Extracranial Vascular Narrowing in Ischemic Stroke: Differences Between Patients With and Without Illicit Drug Use. J Comput Assist Tomogr 2022; 46:929-937. [PMID: 36055121 DOI: 10.1097/rct.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous studies have linked illicit drug consumption and stroke. The purpose of this study is to identify specific imaging findings depicted on computed tomography angiography on patients with illicit drug-associated stroke. METHODS This is a retrospective case-control study that included ischemic stroke patients. Subjects who tested positive for cocaine or marijuana were considered as cases, while patients who tested negative were included as controls. Matching of the controls was carried out based on the presence of stroke risk factors. A previously validated scale was used to calculate narrowing scores through computed tomography angiography. Comparison between cases and matched controls was evaluated by paired t test for age and body mass index, and by Wilcoxon signed rank test for intracranial, extracranial, and total scores. RESULTS One hundred seventy-four patients were included in the study, 87 subjects for each group. Because of matching, baseline status differed only on body mass index, with a greater proportion of obese subjects among controls (P < 0.016). Subgroup analysis demonstrated that it is more likely to find any intracranial abnormality among cocaine consumers when compared with controls (P = 0.041). CONCLUSIONS By using computed tomography angiography, we found that stroke patients with history of cocaine consumption had a higher incidence of intracranial circulation narrowing compared with matched controls.
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McGuinness B, Goel A, Chen J, Szalay D, Ladha K, Mittleman MA, Harlock J. The Association of Cannabis Use Disorder with Acute Limb Ischemia and Critical Limb Ischemia. Vasc Endovascular Surg 2022; 56:480-494. [PMID: 35503434 PMCID: PMC9163779 DOI: 10.1177/15385744221085382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI). METHODS We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology. RESULTS We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay. CONCLUSIONS Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.
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Affiliation(s)
- Brandon McGuinness
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Akash Goel
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Anesthesiology, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Jerry Chen
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - David Szalay
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
| | - Karim Ladha
- Department of Anesthesiology, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Murray A Mittleman
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
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Marinelli L, Puce L, Mori L, Leandri M, Rosa GM, Currà A, Fattapposta F, Trompetto C. Cannabinoid Effect and Safety in Spasticity Following Stroke: A Double-Blind Randomized Placebo-Controlled Study. Front Neurol 2022; 13:892165. [PMID: 35812088 PMCID: PMC9261779 DOI: 10.3389/fneur.2022.892165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nabiximols is a cannabis-based drug to treat spasticity-associated symptoms currently approved for patients with multiple sclerosis only. Cannabinoids are useful in an increasing number of medical conditions but may bear an increased risk for cardiovascular events. SativexStroke is a double-blind randomized placebo-controlled crossover monocentric clinical trial investigating the efficacy and safety of nabiximols in patients with spasticity following stroke. Methods Patients were treated with nabiximols oromucosal spray or placebo and assessed before and after two phases of 1-month duration each. Cardiovascular safety was assessed before and during the trial. Primary endpoints were changes in spasticity numeric rating scale scores and electromyographic recording of the stretch reflex in affected wrist flexors. Secondary outcome measures were numeric rating scale scores for pain, sleep and bladder function, the number of daily spasms and clinical assessment of spasticity with the modified Ashworth scale. The study was registered with the EudraCT number 2016-001034-10. Results Between May 2, 2018, and February 20, 2020, 41 patients entered the study. Seven patients did not complete the study, so 34 were included in the analysis. Two serious adverse events occurred, but none related to cardiovascular function. Primary and secondary efficacy outcome measures did not change from baseline during nabiximols treatment relative to placebo. Conclusion This study suggests that nabiximols use is probably safe in stroke patients, therefore cannabinoid usefulness may be further investigated. The lack of nabiximols effect could be related to low pain levels in recruited patients or different spasticity mechanisms between post-stroke and multiple sclerosis patients. Similarly, a beneficial effect of nabiximols could have emerged if more patients with a higher level of spasticity at baseline were recruited. Clinical Trial Registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-001034-10/IT.
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Affiliation(s)
- Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Clinical Neurophysiology, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Lucio Marinelli
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Neurorehabilitation, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimo Leandri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, A. Fiorini Hospital, Terracina, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Neurorehabilitation, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Greiner KS, Lo JO, Speranza RJ, Rincón M, Burwick RM. Marijuana use and pregnancy outcomes among women with hypertension in pregnancy. J Matern Fetal Neonatal Med 2022; 35:2286-2293. [PMID: 32627608 PMCID: PMC7785625 DOI: 10.1080/14767058.2020.1785422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Marijuana has vasoconstrictive properties and its use has been associated with increased blood pressure in the general population. Yet, there are limited data on marijuana use and adverse outcomes among women with hypertension in pregnancy, even though these disorders are associated with severe maternal and fetal morbidity and mortality. Since marijuana is currently the most commonly used illicit drug in pregnancy, there is an urgent need to better understand the potential association between marijuana use and hypertension in pregnancy. OBJECTIVE To determine the adverse prenatal effects of marijuana use in women with hypertension in pregnancy. STUDY DESIGN We conducted a retrospective cohort study among individuals with hypertension in pregnancy that delivered ≥23 weeks' gestation at Oregon Health & Science University (October 2013-September 2018). The primary exposure assessed was marijuana use, identified by chart review of documented patient self-report or positive urine toxicology screen. Individuals were stratified into two groups by marijuana use: use during pregnancy versus never used. Primary outcomes included composite adverse maternal and neonatal outcomes. Secondary outcomes included individual maternal outcomes, rarer neonatal outcomes and severe features of preeclampsia. Differences were analyzed by Fisher's exact, t-test, and logistic regression. Significance was determined by alpha = 0.05 for primary outcomes and alpha = 0.01 for secondary outcomes. RESULTS From 11,825 deliveries, 1,613 (13.6%) were classified with hypertension in pregnancy. A total of 117 individuals (7.3%) used marijuana during pregnancy, 1,110 (68.2%) had never used marijuana and 396 (24.6%) had unknown marijuana use and were excluded, leaving 1,217 individuals in this analysis. Women using marijuana in pregnancy were more likely to be younger, non-Hispanic White, publicly insured and using other substances compared to women who did not use marijuana. There were no differences in the overall distribution of hypertensive disorders, including preeclampsia with severe features, in women who used marijuana versus those who did not (p = .80). In multivariable analyses, after adjusting for maternal factors and other substance use, marijuana use was not associated with adverse maternal (aOR 1.23, 95% CI 0.43-3.50, p = .69) or neonatal (aOR 0.90, 95% CI 0.28-2.89, p = .86) outcomes. CONCLUSIONS Marijuana use in pregnancy was not associated with maternal or neonatal outcomes or worsened hypertensive disease among women with hypertension in pregnancy after adjusting for maternal characteristics, including use of other substances. Our data highlight the need to consider use of other substances when evaluating the association between marijuana use in pregnancy and adverse pregnancy outcomes.
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Affiliation(s)
- Karen S. Greiner
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Jamie O. Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Rosa J. Speranza
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mónica Rincón
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Richard M. Burwick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Vernail VL, Bingaman SS, Silberman Y, Raup-Konsavage WM, Vrana KE, Arnold AC. Acute Cannabigerol Administration Lowers Blood Pressure in Mice. Front Physiol 2022; 13:871962. [PMID: 35615681 PMCID: PMC9124753 DOI: 10.3389/fphys.2022.871962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 01/27/2023] Open
Abstract
Cannabigerol is a cannabinoid compound synthesized by Cannabis sativa, which in its acid form acts as the substrate for both Δ9-tetraydrocannabinol and cannabidiol formation. Given its lack of psychoactive effects, emerging research has focused on cannabigerol as a potential therapeutic for health conditions including algesia, epilepsy, anxiety, and cancer. While cannabigerol can bind to classical cannabinoid receptors, it is also an agonist at α2-adrenoreceptors (α2AR) which, when activated, inhibit presynaptic norepinephrine release. This raises the possibility that cannabigerol could activate α2AR to reduce norepinephrine release to cardiovascular end organs to lower blood pressure. Despite this possibility, there are no reports examining cannabigerol cardiovascular effects. In this study, we tested the hypothesis that acute cannabigerol administration lowers blood pressure. Blood pressure was assessed via radiotelemetry at baseline and following intraperitoneal injection of cannabigerol (3.3 and 10 mg/kg) or vehicle administered in a randomized crossover design in male C57BL/6J mice. Acute cannabigerol significantly lowered mean blood pressure (-28 ± 2 mmHg with 10 mg/kg versus -12 ± 5 mmHg vehicle, respectively; p = 0.018), with no apparent dose responsiveness (-22 ± 2 mmHg with 3.3 mg/kg). The depressor effect of cannabigerol was lower in magnitude than the α2AR agonist guanfacine and was prevented by pretreatment with the α2AR antagonist atipamezole. These findings suggest that acute cannabigerol lowers blood pressure in phenotypically normal mice likely via an α2AR mechanism, which may be an important consideration for therapeutic cannabigerol administration.
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Affiliation(s)
- Victoria L. Vernail
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Sarah S. Bingaman
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Yuval Silberman
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
| | | | - Kent E. Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, United States
| | - Amy C. Arnold
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States,*Correspondence: Amy C. Arnold,
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Krishnamurthi RV, Feigin VL. Global Burden of Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med 2021; 50:765-772. [PMID: 34879501 DOI: 10.1016/j.ajem.2021.09.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare cause of severe headache that can mimic other causes of sudden, severe headache and result in frequent emergency department (ED) visits. OBJECTIVE This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of RCVS for the emergency clinician. DISCUSSION RCVS can present as recurrent, severe headaches that may be maximal in onset, known as a thunderclap headache. Distinguishing from other causes of thunderclap headache such as aneurysmal subarachnoid hemorrhage, cerebral venous thrombosis, and posterior reversible encephalopathy syndrome is challenging. Risk factors for RCVS include use of vasoactive substances, exertion, coughing, showering, sexual activity, and cervical artery dissection. Diagnosis relies on clinical features and imaging. Cerebral catheter digital subtraction angiography (DSA) is considered the gold standard imaging modality; however, computed tomography angiography or magnetic resonance angiography are reliable non-invasive diagnostic modalities. Treatment focuses on avoiding or removing the offending agent, administration of calcium channel blockers such as nimodipine, and reversing anticoagulation if bleeding is present. Although most cases have a benign course and resolve within 3 months, focal subarachnoid hemorrhage, intracerebral hemorrhage, permanent neurologic disability, or death can occur in a minority of cases. CONCLUSIONS Diagnosis and appropriate management of RCVS can be aided by understanding key aspects of the history and examination. The emergency clinician can then obtain indicated imaging, confirming the diagnosis and allowing for appropriate management.
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Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Kevin R Scott
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
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Shimol JB, Sheinberg O. Development of Raynaud Phenomenon Following Use of Medical Cannabis. J Clin Rheumatol 2021; 27:S430-S431. [PMID: 31977646 DOI: 10.1097/rhu.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boitet R, de Gaalon S, Ducros A. Sindrome da vasocostrizione cerebrale reversibile. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chiu RG, Fuentes AM, Patil SN, Chiu R, McGuire LS, Mehta AI. Cannabis Abuse and Perioperative Complications After Treatment of Intracranial Aneurysms: A Nationwide Analysis. World Neurosurg 2021; 158:e184-e195. [PMID: 34757211 DOI: 10.1016/j.wneu.2021.10.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In the present retrospective cohort analysis, we examined the differences in baseline characteristics and peri- and postoperative outcomes stratified by 3 groups: cannabis abuse or dependence versus none, surgical versus endovascular treatment, and unruptured and ruptured intracranial aneurysms. METHODS A study population of 26,868 patients was defined using the 2009-2016 National Inpatient Sample database. The baseline characteristics were compared between the cannabis and no-cannabis groups, and the traits that differed significantly were factored into the multivariate analysis using 1:1 propensity score matching. The matched groups were analyzed to compare the cannabis and no-cannabis cohorts for the following endpoints: mortality, length of stay, discharge disposition, total hospital charges, and several peri- and postoperative outcomes. RESULTS In the surgically and endovascularly treated groups for unruptured intracranial aneurysms, those in the cannabis group were more likely to be male and younger and to smoke tobacco than were those in the no-cannabis group. After matching, no significant endpoint differences were noted. Similarly, in the surgically and endovascularly treated ruptured aneurysm groups, those in the cannabis group were more likely to be male and younger and to smoke tobacco. After matching, the cannabis group within the endovascular treatment group had had a longer length of stay and were more likely to have developed any hydrocephalus, obstructive hydrocephalus, sepsis, and acute kidney injury. Those in the cannabis group who had undergone surgery were more likely to have developed any hydrocephalus, specifically, communicating hydrocephalus. CONCLUSIONS The cannabis group with ruptured intracranial aneurysms was more likely to experience certain adverse outcomes after surgical or endovascular treatment compared with the no-cannabis group. However, such was not the case for cannabis abusers treated for unruptured aneurysms.
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Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Dutta T, Ryan KA, Thompson O, Lopez H, Fecteau N, Sparks MJ, Chaturvedi S, Cronin C, Mehndiratta P, Nunez Gonzalez JR, Phipps M, Wozniak M, McArdle PF, Kittner SJ, Cole JW. Marijuana Use and the Risk of Early Ischemic Stroke: The Stroke Prevention in Young Adults Study. Stroke 2021; 52:3184-3190. [PMID: 34266309 PMCID: PMC8478805 DOI: 10.1161/strokeaha.120.032811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have examined the dose-response and temporal relationships between marijuana use and ischemic stroke while controlling for important confounders, including the amount of tobacco smoking. The purpose of our study was to address these knowledge gaps. METHODS A population-based case-control study with 1090 cases and 1152 controls was used to investigate the relationship of marijuana use and early-onset ischemic stroke. Cases were first-ever ischemic stroke between the ages of 15 and 49 identified from 59 hospitals in the Baltimore-Washington region. Controls obtained by random digit dialing from the same geographic region were frequency-matched to cases by age, sex, region of residence and, except for the initial study phase, race. After excluding subjects with cocaine and other vasoactive substance use, the final study sample consisted of 751 cases and 813 controls. All participants underwent standardized interviews to characterize stroke risk factors and marijuana use. Unconditional logistic regression analysis was used to assess the relationships between marijuana use and risk of ischemic stroke, adjusting for age, sex, race, study phase, the amount of current tobacco smoking, current alcohol use, hypertension, and diabetes. RESULTS After adjusting for other risk factors, including the amount of current tobacco smoking, marijuana use was not associated with ischemic stroke, regardless of the timing of use in relationship to the stroke, including ever use, use within 30 days, and use within 24 hours. There was a nonsignificant trend towards increased stroke risk among those who smoked marijuana at least once a week (odds ratio, 1.9 [95% CI, 0.8-4.9]). CONCLUSIONS These analyses do not demonstrate an association between marijuana use and an increased risk of early-onset ischemic stroke, although statistical power was limited for assessing the association among very heavy users.
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Affiliation(s)
- Tara Dutta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen A. Ryan
- VA Maryland Health Care System, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Oluwatosin Thompson
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Haley Lopez
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Natalie Fecteau
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Mary J. Sparks
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Carolyn Cronin
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Michael Phipps
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Marcella Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - Patrick F. McArdle
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
| | - John W. Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Health Care System, Baltimore, MD, USA
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Brunet B, Jagailloux Y, Palazzo P, Lelong J, Mura P, Neau JP. Accidents vasculaires cérébraux du sujet jeune et usage de stupéfiants : 2 – Le cas préoccupant du cannabis. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.
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Affiliation(s)
- Erica C Camargo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA.
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Egée S, Kaestner L. The Transient Receptor Potential Vanilloid Type 2 (TRPV2) Channel-A New Druggable Ca 2+ Pathway in Red Cells, Implications for Red Cell Ion Homeostasis. Front Physiol 2021; 12:677573. [PMID: 34177620 PMCID: PMC8222986 DOI: 10.3389/fphys.2021.677573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphane Egée
- Sorbonne Université, CNRS, UMR 8227, Integrative Biology of Marine Models, Station Biologique de Roscoff, Roscoff Cedex, France
- Laboratoire d'Excellence GR-Ex, Paris, France
| | - Lars Kaestner
- Theoretical Medicine and Biosciences, Saarland University, Saarbrucken, Germany
- Experimental Physics, Saarland University, Saarbrucken, Germany
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Olt C, Faulkenberg KD, Hsich EM. The growing dilemma of legalized cannabis and heart transplantation. J Heart Lung Transplant 2021; 40:863-871. [PMID: 34006449 DOI: 10.1016/j.healun.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/06/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
This in-depth review discusses cannabis as it relates to heart transplantation and the growing dilemma of legalization around the world creating disparities in transplant candidacy. One will learn about two of the most common cannabinoids: Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These cannabinoids are metabolized by cytochrome P-450 and P glycoprotein, which are essential for the metabolism of drugs for transplantation, such as calcineurin inhibitors. Addiction, withdrawal, and cannabis use disorder will be reviewed as well as hyperemesis syndrome. Maintaining adequate immunosuppression will depend on a variety of factors, including drug-drug interactions, pharmacokinetics of cannabinoids and chronicity of cannabis usage. These drug interactions are further confounded by varying concentrations of cannabis products available at medical dispensaries. One will also learn about the outcomes of transplant recipients using cannabis such as graft failure and the risk of infections. Although more research is needed to establish transplant guidelines, the available data is concerning and fairness in organ distribution should not vary by transplant program or institution.
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Affiliation(s)
| | | | - Eileen M Hsich
- Heart and Vascular Institute at the Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio.
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31
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Moustafa B, Testai FD. Cerebrovascular Complications Associated with Marijuana Use. Curr Neurol Neurosci Rep 2021; 21:25. [PMID: 33825077 DOI: 10.1007/s11910-021-01113-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW In the last few years, the attitude toward marijuana in many parts of the world has shifted from illicit to legalized for medical use and to decriminalized. In parallel, there has been a gradual increase in the consumption of this product in the general population, particularly among adolescents and young adults. Marijuana is generally perceived as a harmless drug. However, data obtained in observational studies and preclinical models have established associations between cannabis use and cardiovascular events. In addition, there is emerging evidence linking marijuana use to cerebrovascular complications. Here we provide a critical review of the literature with special emphasis on the association of cannabinoids with stroke and the possible pathogenic mechanisms involved. RECENT FINDINGS Ischemic and hemorrhagic stroke have been described in association with cannabis use, particularly in young individuals. Cerebral infarction remains the most commonly reported stroke subtype seen in marijuana users. Several pathogenic mechanisms have been proposed to explain this association, including multifocal intracranial stenosis, reversible cerebral vasoconstriction syndrome, and coexisting vascular risk factors. Cannabis use is increasingly recognized in young individuals presenting with acute stroke. Our understanding of the pathogenic mechanisms associated with cannabis use and stroke is limited but rapidly evolving. Healthcare providers should educate patients about the potential cardiovascular and cerebrovascular complications related to marijuana or cannabinoids use.
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Affiliation(s)
- Bayan Moustafa
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA
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Stroke and cannabis use in patients with no cardiovascular risk factors: a systematic review of case reports. Neurologia 2021; 36:222-228. [PMID: 29277524 DOI: 10.1016/j.nrl.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cannabis and its synthetic analogues are currently the most widely consumed illicit substances worldwide. Multiple alterations have been linked to its use, including cerebrovascular disease (CVD) or stroke, whose association with the substance has been based mainly on the hypothesis of transient vasoconstriction, which explains a large proportion of the cases reported. However, epidemiological studies have not performed an individual analysis of patients without other cardiovascular risk factors, which may limit the estimation of the risk of stroke associated with cannabis use alone. DEVELOPMENT A systematic literature review was conducted through Medline, EBSCOhost, EMBASE, Lilacs, and Scielo to gather case reports published before 13 May 2016 presenting patients with a diagnosis of CVD or transient ischaemic attack, a history of cannabinoid use, and no other cardiovascular risk factors. Key words such as stroke, cerebrovascular disease, cannabis, and marijuana, among others, were used. A total of 18 case reports were selected from the 566 references found. CONCLUSIONS There is a wide variety of reports of stroke associated with cannabis use in patients with no other risk factors. Noteworthy findings were presentation at young age and a strong temporal association, which place cannabis use as a potential risk factor for this population in line with the epidemiological and pathophysiological studies in this area.
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Cannabis use disorder and perioperative outcomes in vascular surgery. J Vasc Surg 2021; 73:1376-1387.e3. [DOI: 10.1016/j.jvs.2020.07.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023]
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Gómez Ochoa S. Stroke and cannabis use in patients with no cardiovascular risk factors: a systematic review of case reports. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Affiliation(s)
- Ankur Wadhwa
- Calgary stroke Program, Fellow Stroke and Cerebrovascular Disorders, Department of Neurology (A.W.), University of Calgary, Mumbai, India
| | - Simerpreet Bal
- Fellowship Stroke and Cerebrovascular Disorders, Department of Clinical Neurosciences, Cumming School of Medicine (S.B.), University of Calgary, Mumbai, India
| | - Oje Imoukhuede
- Fellowship Stroke and Cerebrovascular Disorders, Red Deer Hospital, Alberta, Canada (O.I.)
| | - Darshan Doshi
- Fellowship Stroke and Cerebrovascular Disorders, Department of Neurology (D.D.), University of Calgary, Mumbai, India.,Consultant Neurology, Doshi Nursing Home, Mumbai, India (D.D.)
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Mongiatti M, Bayle P, Lagarrigue A, Fabre D, Telmon N, Lapeyre-Mestre M, Jouanjus E. The cardiovascular health of prisoners who use cannabis: An exploratory study among hospitalised prisoners. Therapie 2020; 75:579-589. [PMID: 32718583 DOI: 10.1016/j.therap.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It is essential that health professionals who practice medicine in prison rely on accurate knowledge about their patients to provide them with adapted care. The use of cannabis can influence the health status of prisoners, but data are lacking regarding the potentially related adverse health consequences. The objective of this descriptive study was to describe the cardiovascular outcomes related to cannabis use in prisoners from several detention centres hospitalised in a French hospital. METHODS In France, prisoners who require a longer than 48-hour hospitalisation are admitted in specific secured polyvalent units called inter-regional secured hospital units (ISHU). Hospitalisations in the ISHU of Toulouse University Hospital between 2012 and 2016 for cardiovascular disorders potentially related to the use of cannabis were extracted from the French hospital database and analysed using a previously validated methodology. Included patients were those hospitalised for an inaugural cardiovascular event or deterioration of a preexisting cardiovascular illness who declared having used cannabis while imprisoned. RESULTS Overall, 31 cardiovascular outcomes were identified in cannabis-using hospitalised prisoners among 411 hospitalisations for cardiovascular disorders (all men, mean age 43±SD years old). All used cannabis (daily: 56%) and tobacco (more than 15 PY: 83.3%), 5 used cocaine, and none used alcohol. The most frequent were coronaropathy (n=13), followed by obliterating arteriopathy of the lower limb (OALL, n=7), arrhythmic cardiomyopathy (n=4), venous thrombosis (n=3), infectious cardiopathy (n=2), and ischemic stroke (n=2). CONCLUSION This description of serious cardiovascular outcomes in prisoners who use cannabis provides insights into the clinical features possibly observed in this vulnerable population The findings indicate that 7.5% of hospitalizations of prisoners for cardiovascular disorders are potentially linked to cannabis used in prison.
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Affiliation(s)
- Marion Mongiatti
- Forensic medicine and medicine in prison environment department, inter-regional secured hospital unit, Toulouse Rangueil university hospital, 31059 Toulouse, France
| | - Paule Bayle
- Forensic medicine and medicine in prison environment department, inter-regional secured hospital unit, Toulouse Rangueil university hospital, 31059 Toulouse, France
| | - Aude Lagarrigue
- Forensic medicine and medicine in prison environment department, inter-regional secured hospital unit, Toulouse Rangueil university hospital, 31059 Toulouse, France
| | - Dider Fabre
- Department of medical information, Toulouse university hospital, Hôtel-Dieu Saint-Jacques, 31059 Toulouse, France
| | - Norbert Telmon
- Forensic medicine and medicine in prison environment department, inter-regional secured hospital unit, Toulouse Rangueil university hospital, 31059 Toulouse, France; AMIS (molecular anthropology and synthesis imagery) laboratory, CNRS 5588, university of Toulouse, 31059 Toulouse, France
| | - Maryse Lapeyre-Mestre
- Pharmacoepidemiology research team, INSERM 1027, university of Toulouse, 31000 Toulouse, France; Addictovigilance center, department of medical and clinical pharmacology, Toulouse university hospital, 31000 Toulouse, France
| | - Emilie Jouanjus
- Pharmacoepidemiology research team, INSERM 1027, university of Toulouse, 31000 Toulouse, France; Addictovigilance center, department of medical and clinical pharmacology, Toulouse university hospital, 31000 Toulouse, France.
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Gökharman FD, Aydin S, Paltun SC, Fatihoğlu E, Yalçin Şahiner Ş, Koşar PN. DTI-MRI findings in synthetic cannabinoid users. Turk J Med Sci 2020; 50:1022-1027. [PMID: 32336074 PMCID: PMC7379452 DOI: 10.3906/sag-1905-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 04/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background/aim Synthetic cannabinoids (SCs) are full agonists of both cannabinoid receptors. Conventional magnetic resonance imaging (MRI) findings of SC users are mainly defined as diffusion restriction and T2/FLAIR hyperintensity. Diffusion tensor imaging (DTI) studies examining SC users have shown contradictory results. The aim of this study was to define white matter (WM) changes of SC users using DTI. Materials and methods The study included 22 patients with a history of using SC for 5–37 months, and 22 healthy, age and sex-matched control subjects. A total of 41 diffusion gradient directions were used in the acquisition of diffusion imaging data. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) values were obtained. ROIs were placed on WM areas of normal appearance. Results In the SC users, significantly lower FA values were determined in the left temporal lobe (216.2 ± 58.9 vs. 263 ± 27.4; P = 0.002) and right hippocampus (224.5 ± 61.5 vs. 255 ± 24.3; P = 0.040). The ADC values of the hippocampus and temporal lobe were significantly higher than those of the control group on both the left and right sides. Conclusion The SC use causes WM microstructural changes, especially in the hippocampus and temporal lobes. DTI is a useful tool to reveal WM changes in SC addicts and can be used earlier than conventional MRI.
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Affiliation(s)
| | - Sonay Aydin
- Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Salih Cihat Paltun
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara Turkey
| | - Erdem Fatihoğlu
- Department of Radiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Şafak Yalçin Şahiner
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara Turkey
| | - Pinar Nercis Koşar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
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San Luis CV, O'Hana S Nobleza C, Shekhar S, Sugg R, Villareal DJ, Mehta T, Gangadhara S. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract 2020; 10:333-339. [PMID: 32983613 DOI: 10.1212/cpj.0000000000000888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/07/2020] [Indexed: 11/15/2022]
Abstract
Background Studies that have analyzed the association between cannabis use and acute ischemic stroke (AIS) have provided conflicting results. In this study, we aim to determine the association of recent cannabis use detected through urine drug screen (UDS) among patients admitted with AIS. Methods A retrospective observational study was performed using the medical records database. All patients aged 18 years and older admitted from January 1, 2015, to December 31, 2017, who underwent urine toxicology testing on admission were included in the analysis. Multivariate logistic regression analysis was performed to analyze independent association between recent cannabis use and AIS. Results A total of 9,350 patients were determined to have undergone UDS during admission, and 18% (1,643) of this had a positive urine cannabis test. Unadjusted risk ratio showed a 50% decrease in risk of AIS among cannabis users (risk ratio = 0.505, 95% confidence interval [CI] 0.425-0.600). The effect was lost after adjusting for age, race, ethnicity, sickle cell disease, dyslipidemia, hypertension, obesity, diabetes mellitus, cigarette smoking, atrial fibrillation, and other cardiac conditions (odds ratio 1.038, 95% CI 0.773-1.394). Conclusion This is one of the few studies analyzing the association of recent cannabis use and AIS using admission urine toxicology test independent of polysubstance use. Although our study has limitations, we did not find an independent association between recent cannabis use and the incidence of AIS. Further studies using urine toxicology tests with larger sample size and including dosage of cannabis exposure should be conducted.
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Affiliation(s)
- Carmela V San Luis
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Christa O'Hana S Nobleza
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Shashank Shekhar
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Rebecca Sugg
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Darren J Villareal
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Tapan Mehta
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Shreyas Gangadhara
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
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Stitt D, Kumar N. Drugs of Abuse and the Nervous System. Continuum (Minneap Minn) 2020; 26:765-784. [DOI: 10.1212/con.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry 2020; 19:179-186. [PMID: 32394566 PMCID: PMC7215066 DOI: 10.1002/wps.20735] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The sale of cannabis for adult recreational use has been made legal in nine US states since 2012, and nationally in Uruguay in 2013 and Canada in 2018. We review US research on the effects of legalization on cannabis use among adults and adolescents and on cannabis-related harms; the impact of legalizing adult recreational use on cannabis price, availability, potency and use; and regulatory policies that may increase or limit adverse effects of legalization. The legalization of recreational cannabis use in the US has substantially reduced the price of cannabis, increased its potency, and made cannabis more available to adult users. It appears to have increased the frequency of cannabis use among adults, but not so far among youth. It has also increased emergency department attendances and hospitalizations for some cannabis-related harms. The relatively modest effects on cannabis use to date probably reflect restrictions on the number and locations of retail cannabis outlets and the constraints on commercialization under a continued federal prohibition of cannabis. Future evaluations of legalization should monitor: cannabis sales volumes, prices and content of tetrahydrocannabinol; prevalence and frequency of cannabis use among adolescents and adults in household and high school surveys; car crash fatalities and injuries involving drivers who are cannabis-impaired; emergency department presentations related to cannabis; the demand for treatment of cannabis use disorders; and the prevalence of regular cannabis use among vulnerable young people in mental health services, schools and the criminal justice system. Governments that propose to legalize and regulate cannabis use need to fund research to monitor the impacts of these policy changes on public health, and take advantage of this research to develop ways of regulating can-nabis use that minimize adverse effects on public health.
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Affiliation(s)
- Wayne Hall
- University of Queensland Centre for Youth Substance Abuse Research, Brisbane, Australia
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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McAbee GN, Morse AM, Cook W, Tang V, Brosgol Y. Neurological Etiologies and Pathophysiology of Cyclic Vomiting Syndrome. Pediatr Neurol 2020; 106:4-9. [PMID: 32107138 DOI: 10.1016/j.pediatrneurol.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/28/2022]
Abstract
Cyclic vomiting syndrome is an idiopathic chronic periodic disorder of childhood which may persist into the adult years. Although cyclic vomiting syndrome is considered a central nervous system disorder, it is often managed by a pediatric gastroenterologist. The practitioner should not assume a gastrointestinal or non-neurological cause of symptoms especially if there are coexisting neurological symptoms and signs or if vomiting does not bring relief; this suggests a possible central nervous system cause, which may necessitate a pediatric neurology consultation. Examples of central nervous system causes of cyclic vomiting syndrome that can have subjective and objective neurological findings include abdominal migraine, certain types of epilepsy, structural lesions (tumors, Chiari malformation, demyelinating disease), mitochondrial disease, autonomic disorders, fatty acid/organic acid disorders, urea cycle defects, and cannabinoid hyperemesis syndrome. Improved familiarity with cyclic vomiting syndrome and its mimics may improve the time to appropriate diagnosis and may reduce morbidity related to cyclic vomiting syndrome.
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Affiliation(s)
- Gary N McAbee
- Division of Child Neurology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York.
| | - Anne Marie Morse
- Division of Child Neurology, Department of Pediatrics, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, Pennsylvania
| | - Ward Cook
- Division of Child Neurology, Department of Pediatrics, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, Pennsylvania
| | - Vivian Tang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York
| | - Yuri Brosgol
- Division of Child Neurology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York
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Siddiqui MT, Bilal M, Singh A, Olivier-Cabrera S, Lebovics E, Schorr-Lesnick B, Dworkin B, Kirby DF. Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome. Neurogastroenterol Motil 2020; 32:e13806. [PMID: 31990435 PMCID: PMC9206874 DOI: 10.1111/nmo.13806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. METHODS We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. RESULTS A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. CONCLUSION Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.
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Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammad Bilal
- Department of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Olivier-Cabrera
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Edward Lebovics
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Beth Schorr-Lesnick
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Brad Dworkin
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
Abstract
Background
Although cannabis is known to have cardiovascular and psychoactive effects, the implications of its use before surgery are currently unknown. The objective of the present study was to determine whether patients with an active cannabis use disorder have an elevated risk of postoperative complications.
Methods
The authors conducted a retrospective population-based cohort study of patients undergoing elective surgery in the United States using the Nationwide Inpatient Sample from 2006 to 2015. A sample of 4,186,622 inpatients 18 to 65 yr of age presenting for 1 of 11 elective surgeries including total knee replacement, total hip replacement, coronary artery bypass graft, caesarian section, cholecystectomy, colectomy, hysterectomy, breast surgery, hernia repair, laminectomy, and other spine surgeries was selected. The principal exposure was an active cannabis use disorder, as defined by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic codes for cannabis dependence and cannabis abuse. The primary outcome was a composite endpoint of in-hospital postoperative myocardial infarction, stroke, sepsis, deep vein thrombosis, pulmonary embolus, acute kidney injury requiring dialysis, respiratory failure, and in-hospital mortality. Secondary outcomes included hospital length of stay, total hospital costs, and the individual components of the composite endpoint.
Results
The propensity-score matched-pairs cohort consisted of 27,206 patients. There was no statistically significant difference between patients with (400 of 13,603; 2.9%) and without (415 of 13,603; 3.1%) a reported active cannabis use disorder with regard to the composite perioperative outcome (unadjusted odds ratio = 1.29; 95% CI, 1.17 to 1.42; P < 0.001; Adjusted odds ratio = 0.97; 95% CI, 0.84 to 1.11; P = 0.63). However, the adjusted odds of postoperative myocardial infarction was 1.88 (95% CI, 1.31 to 2.69; P < 0.001) times higher for patients with a reported active cannabis use disorder (89 of 13,603; 0.7%) compared with those without (46 of 13,603; 0.3%) an active cannabis use disorder (unadjusted odds ratio = 2.88; 95% CI, 2.34 to 3.55; P < 0.001).
Conclusions
An active cannabis use disorder is associated with an increased perioperative risk of myocardial infarction.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Reversible Cerebral Vasoconstriction Syndrome: an Update of Recent Research. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00137-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cannabis use and outcomes after aneurysmal subarachnoid hemorrhage: A nationwide retrospective cohort study. J Clin Neurosci 2020; 72:98-101. [PMID: 31973920 DOI: 10.1016/j.jocn.2019.12.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/31/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cannabis is the most consumed recreational drug in the world. It is possible that cannabis has an association with an increased risk of vasospasm-related strokes and delayed cerebral ischemia (DCI), which are major causes of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Hence, this study aimed to explore the independent relationship between cannabis use and outcomes after aSAH using the 2016 United States Nationwide Inpatient Sample. METHODS This study was conducted using the 2016 National Inpatient Sample with ICD-10 codes. Multivariate logistic regression was used to examine the association between cannabis use, the primary (inpatient mortality) and secondary outcomes. RESULTS There were 42,394 patients identified with aSAH, of whom 925 were identified as cannabis users. Cannabis users and non-users were similar in terms of severity of aSAH. Although the unadjusted mortality rate was lower among cannabis users (16%) than non-users (22%), (p = 0.04), both the age-adjusted odds ratio (OR) (0.83, 95% confidence interval (CI): 0.56; 1.24) and the multivariate-adjusted OR (0.87, 95% CI: 0.54; 1.42) did not reach statistical significance. Secondary outcomes did not reach statistical significance. CONCLUSION In this nationwide cohort, cannabis users with aSAH had similar outcomes compared to nonusers. However, these results are likely limited by underreporting of cannabis use. Future prospective studies are needed to elucidate the pathophysiology and association between cannabis and outcomes following aSAH.
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Archie SR, Cucullo L. Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Front Pharmacol 2019; 10:1481. [PMID: 31920665 PMCID: PMC6915047 DOI: 10.3389/fphar.2019.01481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Apart from being used as a medicine, cannabis or marijuana is the most widely abused recreational drug all over the world. The legalization and decriminalization of cannabis in Canada and various states of USA may be the underlying reason of the widespread popularity of it among young population. Various studies have reported about the relationship between cannabis use and different detrimental effects like cardiovascular, cerebrovascular, and neurological complications among different age groups. Specifically, the young population is getting adversely affected by this, harmful yet, readily accessible recreational drug. Although the mechanism behind cannabis mediated neurological and cerebrovascular complications has not been elucidated yet, the results of these studies have confirmed the association of these diseases with cannabis. Given the lack of comprehensive study relating these harmful complications with cannabis use, the aim of this narrative literature review article is to evaluate and summarize current studies on cannabis consumption and cerebrovascular/neurological diseases along with the leading toxicological mechanisms.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States.,Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX, United States
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Safran SL, Balmer C, Savoldelli G. Reversible cerebral vasoconstriction syndrome during caesarean section. BMJ Case Rep 2019; 12:12/12/e230606. [PMID: 31811105 DOI: 10.1136/bcr-2019-230606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 25-year-old parturient who presented sudden onset and short-lived severe headache caused by reversible cerebral vasoconstriction syndrome (RCVS) during an emergency caesarean section. The syndrome was triggered by phenylephrine administered intravenously to correct arterial hypotension following spinal anaesthesia. RCVS is a clinical and radiological syndrome attributed to transient disturbance in the control of cerebral arterial tone resulting in vasospasms. The syndrome can be precipitated by several triggers, including vasoactive drugs, often used during spinal anaesthesia, illicit drugs, pregnancy and postpartum state. Diagnosis and management can be challenging during pregnancy, peripartum or post partum, since many medications commonly used during these periods must be avoided to prevent triggering RCVS. The aim of this report is to raise the awareness, particularly for anaesthesiologists and obstetricians, of this rare and potentially serious syndrome. We discuss diagnosis, triggers, pathogenesis, clinical course and complications, as well as coordinated multidisciplinary management plans.
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Affiliation(s)
- Szilard Laszlo Safran
- Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland.,Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Balmer
- Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland
| | - Georges Savoldelli
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland .,Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Anzillotti L, Marezza F, Calò L, Banchini A, Cecchi R. A case report positive for synthetic cannabinoids: are cardiovascular effects related to their protracted use? Leg Med (Tokyo) 2019; 41:101637. [PMID: 31683096 DOI: 10.1016/j.legalmed.2019.101637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/05/2019] [Accepted: 09/21/2019] [Indexed: 12/15/2022]
Abstract
The use of synthetic cannabinoids is being increasingly recognised worldwide, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. New substances are constantly being added to the content of synthetic cannabinoids and they are rarely identified on toxicological screening tests. Due to their structures synthetic cannabinoids and their effects have been compared to the psychoactive compound, Δ-9-tetrahydrocannabinol (THC), found in marijuana. On the molecular level, they are potent cannabinoid receptor agonists that also may have affinity for other types of receptors such as those on platelets. Reported symptoms of toxicity include anxiety, agitation, paranoia, hallucinations, tachycardia, hypertension, excessive sweating, nausea, and vomiting. They can also be linked to serious adverse cardiovascular events and can affect the cardiovascular system causing hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block, as well as interfere with the aggregation of platelets. We present a case report of a cardiac tamponade with toxicological findings positive for synthetic cannabinoids. This case highlights the importance of testing routinely for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.
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Affiliation(s)
- Luca Anzillotti
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Francesca Marezza
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Luca Calò
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Antonio Banchini
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Rossana Cecchi
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
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Hidalgo de la Cruz M, Domínguez Rubio R, Luque Buzo E, Díaz Otero F, Vázquez Alén P, Orcajo Rincón J, Prieto Montalvo J, Contreras Chicote A, Grandas Pérez F. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States. Other conditions associated with obstetric stroke include posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and cerebral venous sinus thrombosis.
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Affiliation(s)
- Erica C Camargo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Steven K Feske
- Stroke Division, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA.
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