Chronic Kratom Use as a Potential Risk Factor for Embolic Stroke of Undetermined Source: A Case Report

Kratom (Mitragyna speciosa) is an herbal supplement that has gained popularity for its opioid-like and stimulant effects. Despite its widespread use, the U.S. Food and Drug Administration has issued warnings about its potential toxicity and the risk of cardiovascular and neurological complications. While a range of neurological effects has been reported, its link to ischemic stroke remains unclear. We report a 39-year-old man who developed an embolic stroke of undetermined source (ESUS) after using kratom daily for two years, with no other identifiable risk factors. The patient demonstrated transient ischemia of the middle cerebral artery that resolved spontaneously, associated with multifocal ischemic infarcts on MRI. Extensive cardiac, vascular, and hypercoagulable testing failed to identify an alternative cause. To our knowledge, this is the first reported case of ESUS in the context of chronic kratom use. This case highlights a potential association between long-term kratom consumption and ischemic stroke and underscores the need for further studies to better understand its cerebrovascular effects and possible mechanisms.