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The Clinical Impact of Recent Methamphetamine Exposure in Aneurysmal Subarachnoid Patients
Jeffrey R Vitt1, Roger C Cheng2, Jason Chung3
1UC Davis: University of California Davis.
Background:
Methamphetamines (MA) are a frequently used drug class with potent sympathomimetic properties that can affect cerebral vasculature. Conflicting reports in literature exist about the effect of exposure to MA on vasospasm risk and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to characterize the impact of recent MA use on the timing, severity and features of vasospasm in aneurysmal subarachnoid as well as neurological outcomes.
Methods:
We retrospectively screened 441 consecutive patients admitted to a tertiary care hospital with a diagnosis of SAH who underwent at least one cerebral digital subtraction angiogram (DSA). Patients were excluded if no urinary toxicology screen was performed within 24 hours of admission, if there was a diagnosis of non-aneurysmal SAH, or if ictus was greater than 72 hours from hospital admission. Vasospasm characteristics were collected from DSA and transcranial doppler (TCD) studies and demographic as well as clinical outcome data was abstracted from the chart.
Results:
129 patients were included and 24 tested positive for MA. Among the 312 excluded patients, 281 did not have a urinary toxicology screen and 31 had a non-aneurysmal pattern of SAH or ictus occurring greater than 72 hours from hospital admission. No significant differences were found in respect to patient age, sex, or admission Hunt and Hess Score or Modified Fisher Scale based on MA use. There was no difference in the severity of vasospasm or time to peak severity using either TCD or DSA criteria on multivariate analysis. Aneurysms were more likely to be in the anterior circulation for both groups, however the MA cohort experienced less vasospasm involving the anterior circulation and more isolated posterior circulation vasospasm. There was no difference in delayed cerebral ischemia (DCI) incidence, length of ICU stay, need for ventriculoperitoneal shunt placement, functional outcome at discharge or hospital mortality.
Interpretation:
Recent MA use was not associated with worse vasospasm severity, time to vasospasm, or DCI in aSAH patients. Further investigations about localized MA effects in the posterior circulation and impact on long-term functional outcomes are warranted.
Insights
Recent methamphetamine (MA) use did not worsen vasospasm severity or outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Further research is needed on MA
Area of Science:
- Neurology
- Neurosurgery
- Toxicology
Background:
- Methamphetamine (MA) use is common and affects cerebral vasculature, but its impact on aneurysmal subarachnoid hemorrhage (aSAH) outcomes remains debated.
- Existing literature presents conflicting data regarding MA's influence on vasospasm risk and clinical results in aSAH patients.
- This study investigates how recent MA use affects the timing, severity, and characteristics of vasospasm and neurological outcomes in aSAH.
Approach:
- Retrospective analysis of 441 patients with subarachnoid hemorrhage (SAH) undergoing cerebral digital subtraction angiography (DSA).
- Exclusion criteria included lack of timely toxicology screening, non-aneurysmal SAH, or delayed ictus presentation.
- Vasospasm data from DSA and transcranial Doppler (TCD) were analyzed alongside demographic and clinical outcomes.
Key Points:
- Of 129 included patients, 24 tested positive for MA; no significant demographic or clinical differences were noted between MA users and non-users.
- Multivariate analysis revealed no difference in vasospasm severity or timing between groups based on TCD or DSA.
- MA users showed less anterior circulation vasospasm and more isolated posterior circulation vasospasm, with no differences in delayed cerebral ischemia (DCI), ICU stay, or mortality.
Conclusions:
- Recent MA use is not associated with increased vasospasm severity, delayed cerebral ischemia, or poorer outcomes in aSAH.
- The study suggests a potential localized effect of MA on posterior circulation vasospasm.
- Further research is warranted to explore MA's specific effects on posterior circulation and long-term functional outcomes.
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