Isolated brain metastasis from malignant melanoma of choroid seven years following enucleation.

Cocaine, cannabis, amphetamines and marijuana are the common recreational drugs associated with ischemic and hemorrhagic strokes. The side-effects of acute cannabis intoxication include: (1) psychiatric behavioral abnormalities and increased risk of schizophrenia;[1] (2) cardiovascular tachycardia, supine hypertension, postural hypotension, myocardial infarction, paroxysmal atrial fibrillation and sudden death;[2] (3) cerebral hemorrhagic and recurrent ischemic strokes. The mechanisms postulated in cannabis-related strokes are vasospasm, vasculopathy, postural hypotension with abnormal regulation of the cerebral blood flow and paroxysmal atrial fibrillation.[3] A predilection for infarcts in the posterior circulation as seen in our patient has been attributed to a poor autoregulatory mechanism in this vascular bed as compared to the anterior circulation.[4] Toxicological screening for cannabinoid metabolites should be done in young patients with strokes with no apparent vascular risk factors or evidence of dissection. This holds good even in our country with increasing drug abuse among the youth.