Ischemic stroke after use of the synthetic marijuana "spice"

Abstract

Objectives: To report and associate acute cerebral infarctions in 2 young, previously healthy siblings with use of the street drug known as "spice" (a synthetic marijuana product, also known as "K2"), which they independently smoked before experiencing acute embolic-appearing ischemic strokes.

Methods: We present history, physical examination, laboratory data, cerebrovascular imaging, echocardiogram, ECG, and hospital course of these patients.

Results: We found that in both siblings spice was obtained from the same source. The drug was found to contain the schedule I synthetic cannabinoid JWH-018. Full stroke workup was unrevealing of a stroke etiology; urine drug screen was positive for marijuana.

Conclusions: We found that our 2 patients who smoked the street drug spice had a temporal association with symptoms of acute cerebral infarction. This association may be confounded by contaminants in the product consumed (i.e., marijuana or an unidentified toxin) or by an unknown genetic mechanism. The imaging of both patients suggests an embolic etiology, which is consistent with reports of serious adverse cardiac events with spice use, including tachyarrhythmias and myocardial infarctions.

Figure 1. Patient A imaging

(A) Pre–t-PA CT perfusion of the brain with large area of penumbra in the left MCA territory. (B) Pre–t-PA CT angiogram shows proximal left MCA clot (arrow). (C) Post–t-PA MRI diffusion-weighted imaging sequence showing small areas of infarct in the left MCA distribution. MCA = middle cerebral artery; t-PA = tissue plasminogen activator.

Figure 2. Patient B imaging

(A) CT angiogram showing a proximal left MCA clot (arrow). (B) MRI diffusion-weighted imaging sequence showing large area of infarct in the left MCA distribution. MCA = middle cerebral artery.