Marihuana suistimali ile ilişkili yineleyen inme

Öz

Giriş: Tüm dünyada en çok suistimal edilen maddelerden biridir. Cannabis sativa bitkisinden elde edilir ve temel etkilerini delta-9-tetrahydrocannabinol [THC] ile oluşturur. Klinik etkileri solunum sistemi, santral sinir sistemi, psikiyatrik olarak meydana gelir ve bunlar genellikle geçicidir. Bu rapor kronik kullanımı izleyen komplike ölümcül bir olguyu sunmaktadır. Olgu sunumu: 35 yaşında erkek hasta acile bilinç bozukluğu, ajitasyon ve akut sağ hemipleji ile getirildi. Beyin tomografisinde yalnız kronik infart vardı. Fibrinojen ve D-Dimer dışında tüm laboratuar sonuçları normal aralıkta idi. Beyin Magnetik Rezonans Görüntüleme [MRG] and MR Angiografi [MRA] akut orta serebral arter [OSA] infarktüsüne bağlı lezyonu gösterdi. Ekokardiografi kalp akinezisini ve azalan ejeksiyon fraksiyonunu açıkladı. Yatışının üçüncü günü, yakınları hastanın uzun zamandır bir marihuana çeşidi olan esrarı kronik olarak düzenli kullandığını açıkladılar. Tüm toksikolojik parametrelerin belirlenmesi için örnekler laboratuvara gönderildi, ama THC tek pozitif sonuçtu. Klinik prognoz oldukça kötüydü. Hasta yedinci gün yoğun bakımda kaybedildi. Sonuç: Marihuana kronik kullanımında ölümcül komplikasyonlar ile kardiyovasküler ve serebral sistemlerde ciddi olarak zararlı olabilir.

Anahtar Kelimeler

• Esrar, acil serviste, inme

Recurrent stroke associated with marijuana abuse

Öz

Introduction: It is one of most abused substances all over the world. It is produced from the Cannabis sativa and induces its main effects by delta-9-tetrahydrocannabinol [THC]. Clinical effects consist in respiratory, central nervous system, pshyciatric health, and these are generally transient. This report presents a complicated mortal case followed with chronic use.Case Report: A 35-year-old male patient was brought to the emergency department with unconciousness, agitation and acute right hemiplegia. There was only a chronic infarction on cerebral computerised tomography. All the laboratory results were in normal range except fibrinogen and D-dimer. Cerebral Magnetic Resonance Imaging [MRI] and MR Angiography [MRA] showed the lesion to be related to an acute middle cerebral artery [MCA] infarction. Ecocardiography revealed cardiac akinesia and a decreased ejection fraction. On the third day of admission, his relatives explained his chronic regular abuse of high dose hashish, a kind of marijuana, for along time. Samples were sent to the laboratory for identification of all toxicological parameters; however THC was the only positive result. The clinical prognosis was very poor. He had died in the intensive care unit on the seventh day.Conclusion: Marijuana can be seriously harmful to cardiovascular and cerebral systems with mortal complications in chronic use

Anahtar Kelimeler

• Hashish, emergency department, stroke

Kaynakça

1. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, How- land MA, Hoffman RS: Marijuana. Goldfrank’s Toxicologic Emergencies. Part D. 6th edition. Edited by Goldfrank LR. Apple- ton and Lange 1998:1121-1125.
2. Iversen L. Cannabis and the brain: Brain 2003;126:1252-1270.
3. Clough A, Conigrave K. Managing confidentiality in illicit drugs research: ethical and legal lessons from studies in remote Aborigi- nal communities. Intern Med J 2008;38:60-3.
4. Hii SW, Tam JD, Thompson BR, Naughton MT: Bullous lung dis- ease due to marijuana. Respirology 2008;13:122-7.
5. Nixon PJ. Health effects of marijuana: a review. Pac Health Dialog 2006;13:123-9.
6. Borini P, Guimaraes RC, Borini SB: Possible hepatotoxicity of chronic marijuana usage. Sao Paulo Med J 200;122:110-6.
7. Charles R, Holt S, Kirkham N: Myocardial infarction and mari- juana. Clin Toxicol 1979;14:433-8.
8. Cairns JA, Theroux P, Lewis HD. Antithrombotic agents in coro- nary artery disease. Chest 1998;114:611S-633S.

9. Finsterer J, Christian P, Wolfgang K. Occipital stroke shortly after cannabis consumption. Clin Neurol Neurosur 2004;106:305-8.
10. Alvaro LC, Iriondo I, Villaverde FJ. Sexual headache and stroke in a heavy cannabis smoker. Headache 2002;42:224-6.
11. Vaitkus PT, Barnathan ES. Embolic potential, prevention and man- agement of mural thrombus complicating anterior myocardial in- farction: a meta-analysis. J Am Coll Cardiol 1993;22:1004-9.
12. Thanvi BR, Treadwell SD. Cannabis and stroke: is there a link? Postgrad Med J 2009;85:80-3.
13. Moussouttas M. Cannabis use and cerebrovascular disease. Neu- rologist 2004;10:47-53.
14. Mateo I, Infante J, Gomez Beldarrain M, et al: Cannabis and cere- brovascular disease. Neurologia 2006;21:204.