Fowler James, Fiani Brian, Quadri Syed A, Cortez Vladimir, Frooqui Mudassir, Zafar Atif, Ahmed Fahad Shabbir, Ikram Asad, Ramachandran Anirudh, Siddiqi Javed
Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA.
Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
Case Rep Neurol Med. 2018 Oct 4;2018:1879329. doi: 10.1155/2018/1879329. eCollection 2018.
Methamphetamine or "meth" is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse.
甲基苯丙胺或“冰毒”是苯丙胺类兴奋剂(ATS)中的一种拟交感神经胺,具有极高的滥用潜力。像可卡因和冰毒这类非法滥用的神经兴奋剂会使患者更容易形成动脉瘤,据报道这些患者的动脉瘤破裂年龄更小,且动脉瘤尺寸更小。然而,很少观察到或报道过因滥用甲基苯丙胺导致动脉瘤在不到2周的时间内迅速生长的情况。在本报告中,我们介绍了一名反复滥用甲基苯丙胺的患者,该患者在不到两周的时间内胼周动脉瘤迅速生长。与甲基苯丙胺和ATS滥用相关的中风病理生理学是多因素的,高血压、心动过速和血管疾病被认为是主要机制。动脉瘤的快速生长具有很高的动脉瘤破裂和蛛网膜下腔出血风险,这是一种神经外科急症,因此需要仔细考虑并密切监测。本病例证实了使用甲基苯丙胺对颅内血管的动态时间效应以及这种特定神经兴奋剂与动脉瘤快速形成的关联。鉴于血管病变,对于有甲基苯丙胺滥用史的年轻患者,还应考虑药物性假性动脉瘤的可能性。