To emphasize the need for awareness of hypercoagulability resulting from synthetic marijuana consumption representing a less well-known stroke risk factor yet clinically relevant in young adults. 

Synthetic cannabinoids, (e.g., "K2", "Spice"), have been associated with various neurologic effects. However, very little has been mentioned regarding the hypercoagulability associated with synthetic marijuana use and its potential identification as a stroke risk factor in young adults. Synthetic cannabinoids can possibly cause endothelial dysfunction, increased platelet aggregation, and alterations in the coagulation cascade.

A 27-year-old female with no significant medical history presented to the emergency department agitated, aggressive, and complaining of severe headache after self-reported consumption of K2.  She denied any history of trauma, recent infections, weight loss, hormonal therapy, oral contraceptive use or IV drug use. After two-hour observation, she was noted to have sudden onset right-sided weakness and aphasia. An emergent non-contrast CT-Head was remarkable for ASPECT-score of 2. CT-Angiography of the head and neck revealed an occlusion extending from left internal carotid artery cervical segment to proximal M1 segment, along with a large thrombus in aortic arch and bilateral pulmonary emboli. Endovascular intervention was deferred due to increased risk of hemorrhagic transformation. She was admitted to ICU and started on therapeutic anticoagulation for pulmonary embolism given hemodynamic instability. Basic laboratory tests were within normal limits. Toxicology was positive for synthetic cannabinoids. Coagulation studies and hypercoagulable workup were negative for any underlying inherited factors, or commonly acquired conditions. 

Synthetic marijuana use can lead to hypercoagulability and increase the risk of ischemic strokes, even in young patients without predisposing risk factors. This case underscores the importance of considering substance use, in particular synthetic marijuana, in the differential diagnosis of stroke in young adults, and the need for public health awareness regarding the potential risks of synthetic cannabinoids.