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Review
Stroke and methamphetamine use in young adults: a review
  1. Julia M Lappin1,2,
  2. Shane Darke1,
  3. Michael Farrell1
  1. 1National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
  2. 2School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Julia M Lappin, National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; j.lappin{at}unsw.edu.au

Abstract

Background Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people.

Methods A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered.

Results Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke.

Conclusions There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events.

  • stroke
  • cerebrovascular disease
  • epidemiology

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Footnotes

  • Contributors Dr JML performed the literature searches and conducted the statistical analyses and write-up of the paper. Professors SD and MF contributed to writing the manuscript and to subsequent revisions. All authors have approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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