Impact of Methamphetamine Abuse: A Rare Case of Rapid Cerebral Aneurysm Growth with Review of Literature

Methamphetamine or “meth” is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse.

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Younger age of patients with myocardial infarction correlates with higher number of relatives with history of premature atherosclerosis

10.21203/rs.3.rs-20951/v1 ◽

2020 ◽

Author(s):

Michał Ambroziak ◽

Katarzyna Niewczas-Wieprzowska ◽

Agnieszka Maicka ◽

Andrzej Budaj

Keyword(s):

Myocardial Infarction ◽

Family History ◽

Young Patients ◽

Significant Risk ◽

Control Group ◽

Premature Coronary Artery Disease ◽

Premature Atherosclerosis ◽

Global Issues ◽

Younger Age ◽

History Of

Abstract Background. Premature coronary artery disease belongs to the most pressing global issues in a modern cardiology. Family history appears to be one of the most important and significant risk factors in young patients with myocardial infarction (MI). The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients <50 years with myocardial infarction (MI) compared to patients ≥ 50 years with MI and to young healthy people.Methods. The studied group (MI<50) consisted of 240 patients aged 26-49 years with MI. The control groups consisted of 240 patients (MI≥50) with MI aged 50-92 years and 240 healthy people aged 30-49 years.Results. There were statistically significant differences between the MI<50 and MI≥50 and young healthy groups regarding family history of premature MI/ischaemic stroke and percent of patients with of ≥2 relatives affected including parents, children, siblings, siblings of parents and grandparents (10.8%, 2.9%, 3.7%, respectively; p<0.0001). There was a statistically significant negative correlation between the age of the first episode of MI and the number of relatives with a history of premature MI/stroke (r=0.249, p<0.05) within all MI patients. Statistically significant differences between MI<50 and MI≥50 groups as well as young healthy control group were revealed regarding prevalence of smoking, body mass index (BMI), LDL, HDL, triglycerides (TG) and glucose levels.Conclusions. Younger age of patients with myocardial infarction correlates with a higher number of relatives with a history of premature MI/ischemic stroke. Thus, the family history of premature atherosclerosis involving not only the first-, but also the second-degree relatives, seems to be valuable and could be considered in an individual CVD risk evaluation in young people.

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Managing the Patient With Pulmonary Arterial Hypertension and Methamphetamine Use: A Practical Perspective for the Clinician

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-17.2.55 ◽

2018 ◽

Vol 17 (2) ◽

pp. 55-62 ◽

Cited By ~ 1

Author(s):

Nimaljeet Tarango ◽

Andrea Gergay Baird

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

San Francisco ◽

Medical Center ◽

The United States ◽

Methamphetamine Abuse ◽

Methamphetamine Use ◽

Personal Experiences ◽

History Of ◽

Pulmonary Arterial

Pulmonary arterial hypertension (PAH) is a serious, chronic, progressive cardiopulmonary disease. PAH is associated with several concomitant conditions, as well as drugs and toxins.12 Methamphetamine abuse is likely associated with the development of PAH.3 Methamphetamine abuse is epidemic in the United States and abroad, with rates of new users escalating since 2012. There are over 100,000 new users annually as young as 12 years old. Treating a patient with a history of methamphetamine abuse poses many challenges for a clinician, including nonadherence, therapeutic treatment selection, complex psychosocial issues, and relapse or continued drug abuse. Patients with methamphetamine-associated PAH (Meth-APAH) have higher mortality rates when compared to idiopathic PAH.3 Having a better understanding of the complexities of addiction and working with a multidisciplinary team that includes a social worker to provide care and counseling to these patients can improve their trajectory. In this article, we will offer insight and background into methamphetamine abuse and addiction, as well as discuss a practical approach for clinicians in treating a patient with Meth-APAH, based on the literature, as well as our personal experiences at University of California, San Francisco Medical Center.

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A Case of Successful Pregnancy Outcome with a Large Ovarian Cyst- A Case Report

Pulse ◽

10.3329/pulse.v9i1.31882 ◽

2017 ◽

Vol 9 (1) ◽

pp. 49-53

Author(s):

JR Janna ◽

K Khanam

Keyword(s):

Ovarian Cyst ◽

Fetal Loss ◽

Careful Consideration ◽

Close Monitoring ◽

Ovarian Mass ◽

Successful Pregnancy ◽

Large Ovarian Cyst ◽

History Of ◽

Benign Nature ◽

Incidental Discovery

Ovarian cysts during pregnancy are not uncommon. With increasing use of early antenatal ultrasound, the incidental discovery of adnexal masses during early gestation is a clinically relevant problem that requires careful consideration. Here, we have presented a case in pregnancy with a large ovarian cyst with a history of unilateral oophorectomy in pre-pregnancy state due to complex ovarian mass. She is a case of 26 years old prirnigravid, presented at 8 weeks of gestation with clinical and ultasonographic detection of a large cyst (about 9.2cm x 6.9cm) in the left ovary with suspicion of dermoid cyst. She had a history of right sided oophorectomy due to complex ovarian cyst at her 18 years of age which was histologically proved to be benign. This patient was treated conservatively with relevant investigation and tumour markers which was found insignificant with an aim to continue pregnancy until at least 14 weeks of gestation and was vigilant enough for early detection of any complication. Operative interference was not done at this stage due to increased chance of early fetal loss & clinically benign nature of the tumour. The tumour was persisting and gradually increasing in nature and at 11 weeks gestation it was about 11cm x 10om, suggestive of dermoid. Although clinically stable, with a fairly large ovarian cyst which was increasing in size & with a suspicion of filture torsion that will damage the only persisting ovary, this patient underwent laparotomy followed by ovarian cystectomy at 15 weeks of gestation. Close monitoring of the rest of the pregnancy period was done & it was uneventful except at 32 weeks of gestation she developed PIH which was managed conservatively. She underwent caesarean section at 38 weeks of gestation due to fetal distress.Pulse Vol.9 January-December 2016 p.49-53

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Moyamoya vasculopathy in a young Caucasian woman with significant methamphetamine use

BMJ Neurology Open ◽

10.1136/bmjno-2020-000066 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000066

Author(s):

Tiffany Lin ◽

Charmaine Yam ◽

Su-Ling Lai ◽

Geoffrey Cloud

Keyword(s):

Young People ◽

Young Patients ◽

Caucasian Woman ◽

Cerebrovascular Disorder ◽

Methamphetamine Use ◽

Asian Populations ◽

History Of ◽

Collateral Vessels ◽

Watershed Infarcts ◽

Stroke In Young

BackgroundMoyamoya is a rare cerebrovascular disorder seen predominantly in Asian populations. Methamphetamine use is a recognised cause of stroke in young people, but its pathophysiology is not fully understood. The incidence of moyamoya vasculopathy in methamphetamine-associated stroke is unknown due to a lack of sufficient data. We present a rare case of moyamoya syndrome in a young Caucasian woman with methamphetamine-associated stroke.CaseA 31-year-old Caucasian woman presented with progressive right arm weakness, speech disturbance and seizures on a background of escalating methamphetamine use in the 9 months prior to admission. She did not have a personal or family history of stroke. MRI revealed both embolic and watershed infarcts in bilateral frontal regions and CT angiography showed development of new lenticulostriate collateral vessels. Digital subtraction angiography confirmed steno-occlusive disease of the bilateral anterior circulations and a ‘puff of smoke’ appearance.ConclusionIn young patients who present with stroke with unclear aetiology, it is important to obtain a thorough substance use history. Moyamoya vasculopathy should be considered when evaluating the pathophysiology of stroke in young people.

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Acute Ascending Muscle Weakness Secondary to Medication-Induced Hyperkalemia

Case Reports in Medicine ◽

10.1155/2014/789529 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Lauren A. Kimmons ◽

Justin B. Usery

Keyword(s):

Chronic Kidney Disease ◽

Serum Potassium ◽

Potassium Concentration ◽

Close Monitoring ◽

Drug Induced ◽

Lower Extremity Weakness ◽

Serum Potassium Concentration ◽

Patient Reported ◽

Life Threatening ◽

History Of

Secondary hyperkalemic paralysis is an uncommon but potentially life-threatening consequence of drug-induced disease. We report a case of a 53-year-old female with history of chronic kidney disease presenting to the emergency department with a one-day history of upper and lower extremity weakness and paresthesias. Serum potassium concentration on admission was greater than 8 mEq/L, and serum creatinine was elevated above baseline. Electrocardiogram showed first-degree atrioventricular block with peaked T waves. The patient reported compliance with daily lisinopril 10 mg, spironolactone 25 mg, and 40 mEq twice daily of potassium chloride. Symptoms and electrocardiogram returned to baseline within 24 hours of presentation and serum potassium returned to 4.2 mEq/L at approximately 36 hours without the need for dialysis. This case emphasizes the importance of including such a condition in the differential diagnosis of patients with ascending paralysis and the importance of close monitoring of patients placed on potassium-elevating agents.

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Incidence of smell and taste disorders and associated factors in patients with mild to moderate COVID-19

Otolaryngologia Polska ◽

10.5604/01.3001.0014.3451 ◽

2020 ◽

Vol 74 (6) ◽

pp. 1-5

Author(s):

Alberto Guillén Martínez ◽

Marina Andreu Gálvez ◽

Sara Rodríguez Sanz ◽

Paula Hernández Ruiz ◽

Antonio García Morillas ◽

...

Keyword(s):

Protective Factor ◽

Nasal Congestion ◽

Young Patients ◽

Health Department ◽

Sensory Disorders ◽

Younger Age ◽

History Of ◽

Taste Disorders ◽

Smell Disorders ◽

Observational Descriptive Study

Objectives: To determine the incidence of smell and taste disorders in our health department and to analyse the factors that could be associated with these symptoms in patients with COVID-19. Methods: We conducted an observational descriptive study of all patients with COVID-19 in our health area diagnosed between 2020/03/10 and 2020/04/14. Factors related to smell and taste disorders were analysed. Results: A total of 126 patients, 63 women and 63 men, aged 16–80 years, were included. As many as 69 patients (62.7%) presented hyposmia, and 58 (46%) of them had anosmia. A total of 75 patients (59.5%) presented hypogeusia, and 57 (45.2%) of them had ageusia. The risk factors that were most commonly associated with these disorders were the female sex (adjusted odds ratio, aOR 2.43 for smell disorders and 2.44 for taste disorders), allergic rhinitis (aOR 3.34 for smell disorders) and a younger age. A protective factor was arterial hypertension (aOR 0.51 for smell disorders and 0.35 for taste disorders). A history of tonsillectomy was the risk factor for taste disorder (aOR 5.23). Conclusion: Our results indicate that these sensory disorders occurred more frequently in female patients and in young patients with mild to moderate COVID-19 infection who progressed with mild nasal congestion, posterior rhinorrhoea and without anterior rhinorrhoea. The recovery of taste occurred before the recovery of smell.

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Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

Revista de Chimie ◽

10.37358/rc.18.2.6110 ◽

2018 ◽

Vol 69 (2) ◽

pp. 375-378

Author(s):

Catalin Pricop ◽

Ileana Adela Vacaroiu ◽

Daniela Radulescu ◽

Daniel Andone ◽

Dragos Puia

Keyword(s):

Renal Impairment ◽

Serum Creatinine ◽

Young Patients ◽

Kidney Injury ◽

Contralateral Kidney ◽

Reactive Protein ◽

Ureteral Lithiasis ◽

Unilateral Hydronephrosis ◽

Duration Of Hospitalization ◽

History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Journal of Personalized Medicine ◽

10.3390/jpm11030178 ◽

2021 ◽

Vol 11 (3) ◽

pp. 178

Author(s):

Noah R. Delapaz ◽

William K. Hor ◽

Michael Gilbert ◽

Andrew D. La ◽

Feiran Liang ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Previous History ◽

Current Treatment ◽

Careful Consideration ◽

P Value ◽

Post Traumatic Stress ◽

Increased Risk ◽

History Of ◽

Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

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Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience

The Neuroradiology Journal ◽

10.1177/19714009211000630 ◽

2021 ◽

pp. 197140092110006

Author(s):

Warren Chang ◽

Ajla Kadribegic ◽

Kate Denham ◽

Matthew Kulzer ◽

Tyson Tragon ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Puncture ◽

Conservative Management ◽

Epidural Blood Patch ◽

Female Gender ◽

Regional Hospital ◽

Younger Age ◽

Blood Patch ◽

History Of ◽

The Difference

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

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