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Abstract Details

Acute Ischemic Stroke due to Vasospasm after Daily Vaping of Tetrahydrocannabinol: a Case Report
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
4-019

To describe a case of acute ischemic stroke in a patient vaping THC
Use of electronic nicotine delivery devices, or vaping, has been linked to respiratory failure, myocardial infarction, and death. These devices are also used to inhale tetrahydrocannabinol (THC). However, little is known about the effects of vaping on the central nervous system.
A 32-year-old woman with history of asthma, was intubated for respiratory failure. She is a former smoker and quit cocaine and heroin 4 years ago; recently she has been vaping THC daily, but not nicotine. On hospital day 4, while intubated, she became acutely hypertensive and bradycardic prompting head imaging. Head CT revealed large bilateral frontal and left occipital acute infarcts with early signs of herniation. Cerebral angiogram showed severe bilateral anterior cerebral arteries and moderate middle cerebral arteries vasospasm. Cerebral blood flow velocities measured by transcranial Doppler (TCD) were elevated in these arteries. Lactic acid was 1.0 mmol/L, ESR: 38mm/h, CRP: 1.4 mg/dL. ANA, dsDNA, ANCA, rheumatoid factor, RPR, hepatitis and the viral panels were negative. Lumbar puncture showed WBC: 9/µL, RBC: 1000/µL, protein: 23.6 mg/dL, glucose: 82 mg/dL, no xanthochromia. Urine toxicology was positive for cannabinoid 27 days after admission. Transthoracic echocardiogram with contrast and cardiac monitoring revealed no abnormalities. Intra-arterial verapamil was administered followed by a 28 day course of oral nimodipine with improvement of the serial TCD measurements and clinical status.
To our knowledge, this is the first case of acute stroke in a young patient who was vaping THC only. While the relationship between cannabinoids and stroke is not clearly established, heavy exposure may increase the risk. The positive cannabinoid result one month from admission suggests heavy use which may have triggered severe vasospasm and stroke.
Further investigation of the link between stroke and vaping of THC is urgently needed.
Authors/Disclosures

PRESENTER 		No disclosure on file
Alison Caruana, MD (Stony Brook University Hospital) No disclosure on file
Philip Yeung, MD (Northwell Manhasset) Dr. Yeung has nothing to disclose.
Adrian Marchidann, MD (Kings County Hospital) Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.