Abstract Details

Title Ischemic Stroke in a 28-Year-Old Woman after Smoking Synthetic THC

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 250

Objective

Background BACKGROUND: Synthetic THC is functionally similar to natural THC. It is sold legally under the brand name of Spice, Gold, Yucatan Fire, Aroma, Diablo and K2.

Design/Methods DESIGN/METHODS: K2 is a brand name for a dried herbal blend that can be smoked. Instead of THC, K2 contains synthetic chemicals known as JWH-018 and JWH-073. Sythetic THC causes intoxication, withdrawal, psychosis, seizures, cardiac arrhythmias, myocardial infarction and death. So far, ischemic stroke has never been reported.

Results RESULTS: A previously healthy 28-year-old right-handed woman was brought to the ED with garbled speech and left-sided paralysis. Prior to presentation, the patient smoked K2, felt nauseated and went to sleep at around 11:00PM. Initial vitals were stable, but on exam she had a left-sided hemiplegia, confusion and slurred speech with an NIH stroke scale of 12. The CT scan of the head showed a thrombus in the right middle cerebral artery (figure 1). The MRI confirmed multiple embolic appearing stokes in the right MCA. (figure 2). Analysis for marijuana analogs was performed and tested positive for two known analogs: JWH-018 and JWH-073.

Conclusions CONCLUSIONS: Marijuana binds equally to CB1 and CB2 with receptor affinities of 40 nm and 36 nm, respectively. JWH-018 binds to CB1 with a receptor affinity of 9 nm and to CB2 with an affinity of 2.9 nm. This is likely the reason for the assumption that these products are 4-5 times more potent than marijuana. Synthetic THC also contains beta-agonists resulting in hypertension, palpitations, tachycardia, anxiety, and irritability. In patients who are predisposed to dysrrhythmias, the extra binding of beta-receptors could trigger a dysrrhythmia leading to cardiac thrombus formation. Synthetic THC is a real risk for stroke in patients without prior risk factors.

Authors/Disclosures
PRESENTER	No disclosure on file
Ashish V. Kapoor, MD, FAAN (Neurology Partners of Hudson County)	Dr. Kapoor has nothing to disclose.
David M. Labiner, MD (University of Arizona Health Sciences)	The institution of Dr. Labiner has received research support from CDC.
Krzysztof W. Selmaj (University of Warmia and Mazury)	Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.

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