Sanam Zarei1, Takashi Kitani2, Bilaal Sirdar2
1Children's National Medical Center, 2MedStar Georgetown University Hospital
Objective:
We describe a case of quadriplegia from diffuse spinal cord infarction following unregulated cannabis inhalation.
Background:
Cannabis is a commonly used recreational drug in the United States. Cannabis has been associated with stroke and vasculitis. Suggested mechanisms of disease hinge on activity on cannabinoid receptors 1 and 2 (CB1 and CB2). THC induced CB1 receptor activation has been shown to decrease cerebrovascular autoregulation by increasing cerebral vascular tone resulting in stroke. THC induced CB2 receptor activation has been described to lead to inflammatory sequela such as arteritis, vasospasm and platelet aggregation resulting in thromboangiitis obliterans.
Design/Methods:
Not applicable
Results:
We report a 23 year old patient with no medical comorbidities presenting with hyperacute onset of quadriplegia minutes after inhalation of unregulated cannabis. The patient was found to be hypoxic to the 60s initially. Vitals stabilized after intubation. Exam was significant for diffuse 0/5 muscle strength, diffuse areflexia, loss of sensation to multiple modalities below the level of T1 and marked urinary and fecal retention. Magnetic resonance imaging (MRI) of the brain and spine demonstrated areas of diffusion restriction and T2-hyperintensities in the right cerebellum, left central medulla, cervical, and upper thoracic spinal cord without enhancement. MR angiogram of the spine did not reveal evidence for vascular malformation. Urine drug screen was positive only for cannabis. EEG demonstrated normal posterior dominant rhythm with overlapping diffuse fast charge and intermittent delta slow bursts bilaterally, consistent with diffuse cerebral disturbance. Lumbar puncture demonstrated slight nonspecific pleiocytosis, normal protein and glucose, and infectious workup was negative.
Conclusions:
We report a case of widespread spinal cord and brain infarction leading to quadriplegia from unregulated cannabis exposure. Given absence of other medical comorbidities, this suggests an association between cannabis exposure and infarction. Possible mechanisms include diffuse transient hypoperfusion related to impaired cerebral autoregulation and oxidative stress similar to thromboangiitis obliterans.