Abstract Details

Title Acute Spinal Cord Infarction Following Cannabis Exposure

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-015

Objective We describe a case of quadriplegia from diffuse spinal cord infarction following unregulated cannabis inhalation.

Background

Cannabis is a commonly used recreational drug in the United States. Cannabis has been associated with stroke and vasculitis. Suggested mechanisms of disease hinge on activity on cannabinoid receptors 1 and 2 (CB1 and CB2). THC induced CB1 receptor activation has been shown to decrease cerebrovascular autoregulation by increasing cerebral vascular tone resulting in stroke. THC induced CB2 receptor activation has been described to lead to inflammatory sequela such as arteritis, vasospasm and platelet aggregation resulting in thromboangiitis obliterans.

Design/Methods Not applicable

Results We report a 23 year old patient with no medical comorbidities presenting with hyperacute onset of quadriplegia minutes after inhalation of unregulated cannabis. The patient was found to be hypoxic to the 60s initially. Vitals stabilized after intubation. Exam was significant for diffuse 0/5 muscle strength, diffuse areflexia, loss of sensation to multiple modalities below the level of T1 and marked urinary and fecal retention. Magnetic resonance imaging (MRI) of the brain and spine demonstrated areas of diffusion restriction and T2-hyperintensities in the right cerebellum, left central medulla, cervical, and upper thoracic spinal cord without enhancement. MR angiogram of the spine did not reveal evidence for vascular malformation. Urine drug screen was positive only for cannabis. EEG demonstrated normal posterior dominant rhythm with overlapping diffuse fast charge and intermittent delta slow bursts bilaterally, consistent with diffuse cerebral disturbance. Lumbar puncture demonstrated slight nonspecific pleiocytosis, normal protein and glucose, and infectious workup was negative.

Conclusions We report a case of widespread spinal cord and brain infarction leading to quadriplegia from unregulated cannabis exposure. Given absence of other medical comorbidities, this suggests an association between cannabis exposure and infarction. Possible mechanisms include diffuse transient hypoperfusion related to impaired cerebral autoregulation and oxidative stress similar to thromboangiitis obliterans.

Authors/Disclosures
Sanam Zarei, MD (Children's National Medical Center) PRESENTER	Dr. Zarei has received intellectual property interests from a discovery or technology relating to health care.
Takashi Kitani, MD (MedStar Georgetown University Hospital)	Dr. Kitani has nothing to disclose.
Bilaal Sirdar, MD (MedStar Georgetown University Hospital)	Dr. Sirdar has nothing to disclose.

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