Table 3

Methamphetamine-related stroke reported in case control and epidemiological studies

PublicationSubject characteristicsFindings
Toffol et al 15 15–45 years
Spontaneous intracerebral haemorrhage series n=72 of whom n=5 (7%) amphetamine
Five cases related to amphetamines (four oral; one IV). Three in cerebral lobes and two basal ganglia (putamen). All arteriograms normal.
Kaku and Lowenstein20 15–44 years case–control, ischaemic and haemorrhagic stroke n=214 illicit drugs, of whom n=12 (6%) amphetamineRelative risk of stroke in illicit drug use: 6.5 (ischaemic) and 11.7 (haemorrhagic) in those aged 35 and below. Of 12 cases caused by amphetamine:
Eight haemorrhagic: two subarachnoid and six intracerebral
Four ischaemic: two thrombotic and two embolic.
Sloan et al 21 15–44 years ischaemic stroke series n=51 of whom n=1 (2%) amphetamineRisk factors in those with substance use: higher rates smoking; lower rates hypertension and diabetes. Mechanism in those with substance use: cardioembolic, large and small vessel occlusive disease.
Petitti et al 24 15–44 years incident stroke in women retrospective case–control n=347 illicit drugs, of whom n=20 (6%) amphetamine/cocaine n=1021 controlsAmphetamine use associated with a 3.8 times higher risk for stroke than no substance use.
Separate ORs for haemorrhagic and ischaemic stroke not reported.
Westover et al 25 18–44 years
Population-based study of hospitalised stroke n=937 haemorrhagic and n=998 ischaemic
Amphetamine abuse strongly associated with haemorrhagic stroke (OR=4.95) but not with ischaemic stroke (OR=1.04). Strength of association between haemorrhagic stroke and amphetamine use more than double that of cocaine or tobacco, but less than that of cerebrovascular anomalies, intracranial tumours and hypertension.
Amphetamine use associated with increased risk of death following haemorrhagic stroke.
Ho et al (2009)All-age methamphetamine-associated stroke series n=10 ischaemic and n=20 haemorrhagic11 ICH: locations typical for hypertensive ICH: basal ganglia, thalamus, pons, subcortical white matter.
9 SAH: all secondary to aneurysm.
Postmortem exam in one case of ischaemic stroke found accelerated atherosclerosis, but no evidence of inflammation.
Phillips et al 16 15–50 years
Ischaemic stroke series n=326 n=19 (6%) amphetamines, predominantly intravenous
High rate (9%) of strokes in anterior and posterior circulations concurrently. 24% of these used amphetamine intravenously, significantly higher prevalence than in population as a whole, suggestive that intravenous amphetamine use may cause simultaneous infarction in multiple sites.
Beadell et al 30 All-age spontaneous intracerebral haemorrhage cohort n=374 n=28 (7%) methamphetamineMethamphetamine users had worse outcomes than age-matched controls at discharge (Glasgow Outcome Scale score).
Moon et al 31 All-age series of aneurysmal subarachnoid haemorrhage n=398 n=31 (8%) methamphetamineMethamphetamine use associated with higher rates tobacco and cocaine use and younger age. No association with severity of presentation but methamphetamine use independently predicted poorer outcomes at 1 and 3 years (Glasgow Outcome Scale), despite strong association of older age and poor outcome.
Nakagawa et al 32 All-age spontaneous intracerebral haemorrhage cohort n=193 n=25 (13%) methamphetamineHigher prevalence of methamphetamine use among Native Hawaiian and Other Pacific Islanders (24%) compared with White (0%) and Asian (12%). Conclude racial disparities in methamphetamine-associated intracerebral haemorrhage.
Huang et al 26 All-age stroke series n=1315 methamphetamine users n=54 stroke eventsSignificantly higher incidence of haemorrhagic stroke compared with control group in the methamphetamine cohort (Hazard Ratio=2.09; p=0.001), but no significant difference for ischaemic stroke or subarachnoid stroke.
  • ICH, Intracerebral haemorrhage; SAH, subarachnoid haemorrhage.