Impact of Methamphetamine Abuse: A Rare Case of Rapid Cerebral Aneurysm Growth with Review of Literature

Abstract

Methamphetamine or "meth" is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse.

Figure 1

Imaging study upon patient's arrival at the hospital in 2012. (a) CT head without contrast showing diffuse subarachnoid hemorrhage that originated from an aneurysm identified by (b) Cerebral angiogram. (c) Cerebral angiogram imaging after coiling of an aneurysm.

Figure 2

Imaging upon hospitalization in 2016. (a) CT head without contrast in 2016 showing intracerebral hemorrhage adjacent to the previously coiled aneurysm. (b and c) Cerebral angiogram of the anterior and posterior circulations showing the development of multiple new aneurysms.

Figure 3

(a) 5 days after discharge in 2016: CT head shows large intracerebral hematoma. (b) A diagnostic cerebral angiogram less than 3 weeks from previous imaging demonstrating interval development of a saccular aneurysm at the callosomarginal and pericallosal bifurcation. (c) Cerebral angiogram postcoiling.