Cannabis-associated angiopathy: an uncommon cause of crescendo transient ischemic attacks.

M ultifocal angiopathy associated with cannabis consumption is an uncommon cause of ischemic stroke in young individuals. The main radiological characteristics include the presence of multifocal intracranial stenosis and the reversibility of vasoconstriction after cannabis withdrawal. 1–3 Cannabis use has been linked recently to other arterial complications, including myocardial infarction (strong temporal link between the occurrence of myocardial infarction and cannabis consumption) and lower limb arteritis with distal arterial occlusions. 4 We describe the neuroimaging findings of a 42-year-old man with a >20-year history of daily cannabis consumption who presented with crescendo transient ischemic attacks manifesting with acute (<48 hours), transient (n=5) episodes of right hemiparesis. The patient was not using other illicit drugs or medications. He reported no history of smoking or excessive alcohol consumption. He did not have a family history of stroke or angiopathy. His blood pressure levels at the emergency department were elevated (168/95 mm Hg). Brain MRI showed a left putaminal infarction. Brain magnetic resonance angiogra-phy and transcranial color-coded duplex sonography disclosed multifocal intracranial stenosis (Figure, A and B) affecting bilateral middle and left posterior cerebral arteries. Diagnostic work-up disclosed no other vascular risk factors such as hyper-cholesterolemia, paroxysmal atrial fibrillation, coagulation disorders, and autoimmune diseases. After 4 days of hospitalization , the patient was given antiplatelets (aspirin 100 mg) and discharged with strict orders to discontinue cannabis consumption. The patient experienced no symptoms after abrupt cannabis discontinuation, and follow-up neuroimaging at 3 months showed complete reversibility of multifocal intracranial stenosis (Figure, C and D). The patient remains free of recurrent cerebrovascular events at 8 months after his hospital admission.