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A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse.
J Clin Med. 2019 Aug 23; 8(9)JC

Abstract

Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Several common mechanisms have been identified, such as arrhythmias and cardioembolism, hypoxia, vascular toxicity, vascular spasm and effects on the thrombotic mechanism, as causes for ischemic stroke. For hemorrhagic stroke, acute hypertension, aneurysm formation/rupture and angiitis-like changes have been implicated. In AAS abuse, the effect of blood pressure is rather substance specific, whereas increased erythropoiesis usually leads to thromboembolism. Transient vasospasm, caused by synthetic cannabinoids, could lead to ischemic stroke. Opiates often cause infective endocarditis, resulting in ischemic stroke and hypereosinophilia accompanied by pyogenic arthritis, provoking hemorrhagic stroke. Genetic variants are linked to increased risk for stroke in cocaine abuse. The fact that case reports on cannabis-induced stroke usually refer to the young population is very alarming.

Authors+Show Affiliations

Center of Toxicology Science & Research, Medical School, University of Crete, 71003 Heraklion, Crete, Greece.Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania. ancadocea@gmail.com.Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania. calinadaniela@gmail.com.Department of Cardiology, University Hospital of Larissa, 41221 Larissa, Greece.Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania. Department of Cardiology, University and Emergency Hospital, 050098 Bucharest, Romania.Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol 61615-585, Iran.Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54248 Thessaloniki, Greece.Department of Neurology, Stroke Unit, University of Thessaly, University Hospital of Larissa, 41221 Larissa, Greece.Department of Neurology, Stroke Unit, University of Thessaly, University Hospital of Larissa, 41221 Larissa, Greece.Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece.Department of Cardiothoracic Surgery, University General Hospital of Heraklion, University of Crete, Medical School, 71003 Heraklion, Crete, Greece.Department of Hazardous Substances, Mixtures and Articles, General Chemical State Laboratory of Greece, 10431 Athens, Greece.Department of Neurology, School of Medicine, University of Crete, 71003 Heraklion, Greece. Comprehensive Stroke Center and Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA.Department of Immunology, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania. neagu.monica@gmail.com. Department of Pathology, Colentina Clinical Hospital, 021183 Bucharest, Romania. neagu.monica@gmail.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31450861

Citation

Tsatsakis, Aristides, et al. "A Mechanistic and Pathophysiological Approach for Stroke Associated With Drugs of Abuse." Journal of Clinical Medicine, vol. 8, no. 9, 2019.
Tsatsakis A, Docea AO, Calina D, et al. A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse. J Clin Med. 2019;8(9).
Tsatsakis, A., Docea, A. O., Calina, D., Tsarouhas, K., Zamfira, L. M., Mitrut, R., Sharifi-Rad, J., Kovatsi, L., Siokas, V., Dardiotis, E., Drakoulis, N., Lazopoulos, G., Tsitsimpikou, C., Mitsias, P., & Neagu, M. (2019). A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse. Journal of Clinical Medicine, 8(9). https://doi.org/10.3390/jcm8091295
Tsatsakis A, et al. A Mechanistic and Pathophysiological Approach for Stroke Associated With Drugs of Abuse. J Clin Med. 2019 Aug 23;8(9) PubMed PMID: 31450861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse. AU - Tsatsakis,Aristides, AU - Docea,Anca Oana, AU - Calina,Daniela, AU - Tsarouhas,Konstantinos, AU - Zamfira,Laura-Maria, AU - Mitrut,Radu, AU - Sharifi-Rad,Javad, AU - Kovatsi,Leda, AU - Siokas,Vasileios, AU - Dardiotis,Efthimios, AU - Drakoulis,Nikolaos, AU - Lazopoulos,George, AU - Tsitsimpikou,Christina, AU - Mitsias,Panayiotis, AU - Neagu,Monica, Y1 - 2019/08/23/ PY - 2019/07/31/received PY - 2019/08/19/revised PY - 2019/08/21/accepted PY - 2019/8/28/entrez PY - 2019/8/28/pubmed PY - 2019/8/28/medline KW - amphetamines KW - anabolic androgenic steroids KW - cannabis KW - cocaine KW - heroin KW - morphine KW - stroke KW - synthetic cannabinoids JF - Journal of clinical medicine JO - J Clin Med VL - 8 IS - 9 N2 - Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Several common mechanisms have been identified, such as arrhythmias and cardioembolism, hypoxia, vascular toxicity, vascular spasm and effects on the thrombotic mechanism, as causes for ischemic stroke. For hemorrhagic stroke, acute hypertension, aneurysm formation/rupture and angiitis-like changes have been implicated. In AAS abuse, the effect of blood pressure is rather substance specific, whereas increased erythropoiesis usually leads to thromboembolism. Transient vasospasm, caused by synthetic cannabinoids, could lead to ischemic stroke. Opiates often cause infective endocarditis, resulting in ischemic stroke and hypereosinophilia accompanied by pyogenic arthritis, provoking hemorrhagic stroke. Genetic variants are linked to increased risk for stroke in cocaine abuse. The fact that case reports on cannabis-induced stroke usually refer to the young population is very alarming. SN - 2077-0383 UR - https://www.unboundmedicine.com/medline/citation/31450861/A_Mechanistic_and_Pathophysiological_Approach_for_Stroke_Associated_with_Drugs_of_Abuse L2 - http://www.mdpi.com/resolver?pii=jcm8091295 DB - PRIME DP - Unbound Medicine ER -
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