Objective:

To characterize acute ischemic stroke (AIS) diagnostic evaluations in young adults with and without substance use.

Background:

Design/Methods:

We performed a retrospective review of consecutive AIS patients aged 18-55 years admitted to a tertiary-level comprehensive stroke center between 2020 and 2023. Cases were defined by use of cocaine, marijuana, methamphetamine, opioids, or other illicit substances within 30 days of presentation, identified by self- or surrogate-report, or positive urine drug screen (UDS). Of the 354 patients screened for eligibility, we analyzed 40 cases and compared them to 40 matched controls without substance use.

Results:

The cohort included 80 patients, with median age of 46 years, 64% men, and 65% white race. UDS was completed for 23 cases (57.5%), and 9 controls (22.5%). Marijuana was identified in 30 cases (75%), methamphetamine in 11 (27.5%), cocaine in 4 (10%), opioids in 4 (10%), and other substances (inhalants, benzodiazepines) in 2 (5%). Multiple substances were present in 9 cases (22.5%). Substance use was documented as a stroke mechanism in 13 (32.5%) cases, most commonly for those with methamphetamine use (10/13). Of the 13 cases and 14 controls with cryptogenic stroke mechanism, 8 cases and 11 controls underwent prolonged cardiac monitoring, 8 cases and 8 controls underwent hypercoagulability testing, and 4 cases and 8 controls underwent both.

Conclusions:

Clinical practice varies regarding UDS testing for young adult AIS patients. Positive results may yield diagnostic information and allow for counseling, but a focus on substance use as stroke etiology also has the potential to result in undertesting for other important etiologies, such as hypercoagulability or cardioembolic phenomena. Further research on substance use in ischemic stroke is warranted.