Abstract Details

Title Substance Use in Young Adult Acute Ischemic Stroke Patients: A Preliminary Report of Toxicology Screens and Diagnostic Evaluations

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-001

Objective To characterize acute ischemic stroke (AIS) diagnostic evaluations in young adults with and without substance use.

Background

In AIS, the lack of guidelines for both toxicology screening and the management of substance-use related stroke leads to inconsistencies in clinical practice.

Design/Methods We performed a retrospective review of consecutive AIS patients aged 18-55 years admitted to a tertiary-level comprehensive stroke center between 2020 and 2023. Cases were defined by use of cocaine, marijuana, methamphetamine, opioids, or other illicit substances within 30 days of presentation, identified by self- or surrogate-report, or positive urine drug screen (UDS). Of the 354 patients screened for eligibility, we analyzed 40 cases and compared them to 40 matched controls without substance use.

Results The cohort included 80 patients, with median age of 46 years, 64% men, and 65% white race. UDS was completed for 23 cases (57.5%), and 9 controls (22.5%). Marijuana was identified in 30 cases (75%), methamphetamine in 11 (27.5%), cocaine in 4 (10%), opioids in 4 (10%), and other substances (inhalants, benzodiazepines) in 2 (5%). Multiple substances were present in 9 cases (22.5%). Substance use was documented as a stroke mechanism in 13 (32.5%) cases, most commonly for those with methamphetamine use (10/13). Of the 13 cases and 14 controls with cryptogenic stroke mechanism, 8 cases and 11 controls underwent prolonged cardiac monitoring, 8 cases and 8 controls underwent hypercoagulability testing, and 4 cases and 8 controls underwent both.

Conclusions Clinical practice varies regarding UDS testing for young adult AIS patients. Positive results may yield diagnostic information and allow for counseling, but a focus on substance use as stroke etiology also has the potential to result in undertesting for other important etiologies, such as hypercoagulability or cardioembolic phenomena. Further research on substance use in ischemic stroke is warranted.

Authors/Disclosures
Emily R. Fisher, MD PRESENTER	Dr. Fisher has nothing to disclose.
Chad M. Aldridge, PT	Dr. Aldridge has nothing to disclose.
Rohini Bhole, MD, MS, FAAN (University of Virginia Health System)	Dr. Bhole has nothing to disclose.
Bradford B. Worrall, MD, MSc, FAAN (University Of Virginia Health System)	The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Worrall has received research support from NIH. The institution of Dr. Worrall has received research support from AHA/ASA.
Karen C. Johnston, MD, MSC (University of Virginia)	Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of Pittsburg. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mayo Clinic. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of California Irvine. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NIH. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FDA. The institution of Dr. Johnston has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Johnston has received research support from NIH.
Nassima Ait-Daoud Tiouririne, MD	Dr. Ait-Daoud Tiouririne has nothing to disclose.

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