Our study aimed to investigate the role of methamphetamine use in the development of CSVD.

Methamphetamine (Meth) use is a risk factor for stroke. The mechanism of Meth-associated stroke is unclear. Cerebral small vessel disease (CSVD) is common cause of acute ischemic stroke (AIS).

This is a retrospective study of patients with AIS from January 1, 2013 to December 31, 2018. Meth-AIS was defined as patients with AIS and Meth use per history or positive urine drug test at admission. Age- and gender-matched AIS cases caused by other etiologies during the study period were included as Non-Meth-AIS group. Baseline characteristics, presence and severity of CSVD on imaging studies, and clinical outcomes were compared between Meth- and Non-Meth AIS. Sensitivity analysis was performed to compare Meth-AIS with Non-Meth-AIS.

Among the 1369 consecutive patients admitted for AIS, 57 were identified to have Meth use per history and/or urine drug test. Demographic characteristics and past medical histories of Meth (n=57) vs Non-Meth AIS (n=57) were similar except for a higher proportion of caucasians in Meth-AIS (78.9% vs 43.9%). Patients with Meth-AIS have more severe CSVD, including white matter hyperintensities (WMH), lacunes and total disease burden. Sensitivity analysis confirmed significantly higher WMH score and total burden remain in Meth-AIS with both history of Meth use and positive urine drug test (n=24). There is no significant difference in clinical outcomes between the 2 groups.

Patients with Meth-AIS had more severe CSVD than those with Non-Meth AIS. CSVD may contribute to the development of Meth-AIS.