December 3, 2013
Seemant Chaturvedi, MD reviewing Freeman MJ et al. Neurology 2013 Nov 8.Two cases of stroke in siblings who had recently smoked “spice” point to a possible association.Ischemic stroke in young adults accounts for about 15% of all strokes.
The causes can be heterogeneous, and some events remain unexplained (cryptogenic). Newly indentified mechanisms and causative agents are, therefore, of interest.These authors describe the occurrence of ischemic stroke in two siblings. In the first patient, a 26-year-old man, stroke occurred within hours of smoking “spice,” a synthetic marijuana that is an increasingly popular recreational drug. Investigations failed to reveal an arterial cause or hypercoagulable state. Despite a negative echocardiogram, the imaging studies were suggestive of an embolic stroke. His 19-year-old sister later presented with a left middle cerebral artery territory stroke. History taking was limited by the patient’s aphasia, but toxicology studies showed the presence of JWH-018, a synthetic cannabinoid found in spice. No other stroke etiology was identified.
COMMENTA consensus panel recently convened by the American Academy of Neurology published a document on recognition and management of stroke in young adults (Neurology 2013; 81: 1089). This publication emphasized the fact that untangling the etiology of stroke in young adults can be challenging. In the current report, circumstantial evidence supports a relationship between spice use and the development of stroke. However, the authors rightly point out that there may be an undiscovered genetic cause in these two siblings. Further reports will be of interest to see whether spice could be a “smoking gun” in some cases of otherwise cryptogenic stroke.
Editor Disclosures at Time of Publication
CITATION(S): Freeman MJ et al. Ischemic stroke after use of the synthetic marijuana “spice.” Neurology 2013 Nov 8; [e-pub ahead of print]. (http://dx.doi.org/10.1212/01.wnl.0000437297.05570.a2) COMME- See more at: http://www.jwatch.org/na32956/2013/12/03/synthetic-cannabinoids-and-stroke-smoking-gun?query=etoc_jwpsych#sthash.7Cq3JeQ8.dpuf