To describe clinical correlation between cannabis and stroke in young people.

20-year-old male presented with right hand weakness, word finding difficulties, nausea, and headache. He reported to smoking marijuana just prior to the onset of his symptoms. NIHSS was 2 upon presentation with return to baseline (NIHSS of 0) within 24 hours of administration of tissue plasminogen activator (tpA). Diagnostic studies revealed left middle cerebral artery distribution stroke, unremarkable coronary tomography angiography (CTA), negative bilateral lower extremity dopplers and unremarkable hypercoagulability workup. Transesophageal echocardiogram (TTE) revealed patent foramen ovale (PFO), aneurysmal septum, and persevered cardiac function without evidence of atrial myopathy. He was encouraged to quit marijuana and was started on aspirin 325 mg and Lipitor 40 mg for secondary stroke prevention. He was discharged to home with 30-day cardiac monitoring, which was negative for arrhythmia. Cardiology recommended PFO closure.

Several mechanisms for stroke associated with cannabis have been proposed: increased platelet aggregation, oxidative stress causing endothelial dysfunction, intracranial arterial stenosis, reversible cerebrovasoconstriction syndrome, arterial dissection and atrial fibrillation. Some studies reflect onset of stroke during or shortly after cannabis use with high risk of recurrence upon continued use.

This case further contributes to the growing knowledge on the association between cannabis use and ischemic stroke, especially in young people. Stroke workup in a young adult should include screening for THC and counseling against their use to prevent recurrence of stroke. Further studies should be done for further understanding of the relationship between cannabis use and stroke. Additionally, the spread of awareness to the public about the hazards of cannabinoid use should be a top priority.