Fujioka Tomohiro, Higashida Kyoko, Hatayama Naoki, Nagashima Nozomi, Shimada Yuki, Fukasaka Isao, Shimizu Mikito, Sumikura Hiroyuki, Hoshi Taku, Takasugi Junji, Sakaguchi Manabu
Department of Neurology, Osaka General Medical Center, Osaka, Osaka, Japan.
Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.cr.2025-0003. Epub 2025 May 10.
The global increase in methamphetamine abuse has increased the incidence of methamphetamine-associated cardiomyopathy (MACM), which is often complicated by left ventricular thrombosis and acute ischemic stroke. Here, we report a case of left internal carotid artery occlusion during acute heart failure treatment in a patient with MACM that led to mechanical thrombectomy.
A 54-year-old man with a history of approximately 30 years of methamphetamine abuse presented with dilated cardiomyopathy complicated by a left ventricular thrombus. On the night of admission for acute heart failure management, he experienced a sudden onset of consciousness disturbance, severe aphasia, and right hemiparesis. MRI revealed mild hyperintensities in the left cerebral hemisphere cortex and lenticular nucleus on diffusion-weighted imaging, with no abnormal signals on fluid-attenuated inversion recovery. He underwent mechanical thrombectomy, achieving complete reperfusion within 150 min; however, he experienced ipsilateral cerebral hyperemia that persisted for 30 days postoperatively. By the 90th postoperative day, moderate aphasia and mild paralysis of the right upper limb remained, with a modified Rankin Scale score of 3.
Left ventricular thrombosis is relatively common in patients with MACM, necessitating careful consideration of the risk of cardioembolic stroke.
全球甲基苯丙胺滥用情况增加，导致甲基苯丙胺相关性心肌病（MACM）的发病率上升，MACM常并发左心室血栓形成和急性缺血性卒中。在此，我们报告1例MACM患者在急性心力衰竭治疗期间发生左颈内动脉闭塞并接受机械取栓术的病例。
一名有大约30年甲基苯丙胺滥用史的54岁男性，表现为扩张型心肌病并伴有左心室血栓。在因急性心力衰竭入院当晚，他突然出现意识障碍、严重失语和右侧偏瘫。磁共振成像（MRI）显示，在弥散加权成像上左脑半球皮质和豆状核有轻度高信号，在液体衰减反转恢复序列上无异常信号。他接受了机械取栓术，在150分钟内实现了完全再灌注；然而，术后他出现了同侧脑充血，持续了30天。术后第90天，仍有中度失语和右侧上肢轻度瘫痪，改良Rankin量表评分为3分。
左心室血栓形成在MACM患者中相对常见，需要仔细考虑心源性栓塞性卒中的风险。
