Substance abuse is a major health crisis in the US, with an estimated 20 million people suffering from substance use disorders (SUD). In addition to rising rates of SUD, Kentucky is located in the northern region of the stroke belt, with one of the highest rates of stroke hospitalizations in the US. Substance may cause stroke by various mechanisms, including vasoconstriction, endothelial dysfunction, drug-induced vasculopathy, advanced atherosclerosis, and infective endocarditis. 

This is a single center, retrospective chart review of adults age >18 years with a diagnosis of ischemic or hemorrhagic stroke, and SUD based on urine drug testing or medical record history, admitted between 12/6/2015 and 5/10/2019. We collected length of stay (LOS), admission/discharge NIHSS, discharge modified Rankin Scores, ICH scores, and discharge status and compared them to controls of ischemic stroke without SUD (AIS/SUD-).

A total of 197 cases were identified [M=147 (74.6%)]. The most common illicit substances identified were stimulants (42.6%, n=84), opioids (32.5%, n=64), and benzodiazepines (28.4%, n=56).  Most subjects had multiple substances present on screening. 13.8% (n=27) and 5.6% (n=11) received thrombolysis with either IV alteplase or mechanical thrombectomy, respectively. Compared to the control group (n= 176), cases were younger (mean=54.94+/-12.01 vs 66.15 +/- 14.38 yrs , p=0.0137), had a longer LOS (n=139, mean=8.44+/-10.84 vs 5.06 +/- 5.74, p=0.0006), higher admission NIHSS (mean=9.87+/-9.08, p=0.00012), and higher discharge NIHSS (mean=6.51+/-7.13 vs 4.19 +/- 5.73 , p=0.000512).

Patients with SUD and stroke had longer LOS and worse discharge NIHSS compared to AIS/SUD- controls. This could result from different etiologic mechanisms in substance uses with AIS, or could reflect the effects of specific substances present at the time of admission. Future directions include evaluating a hemorrhagic control population, and a subpopulation of infective endocarditis.