Methamphetamine-related stroke reported in case control and epidemiological studies
| Publication | Subject characteristics | Findings |
| 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%) amphetamine | Relative 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%) amphetamine | Risk 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 controls | Amphetamine 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 haemorrhagic | 11 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%) methamphetamine | Methamphetamine 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%) methamphetamine | Methamphetamine 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%) methamphetamine | Higher 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 events | Significantly 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.