Ischemic cerebrovasular accident, uncontrolled seizures and acute myocardial infarction associated with synthetic marijuana abuse

Introduction: Designer Cannabinoids is a newly emerging drug of abuse that gained popularity among adolescent and young adults in the past few years. These drugs are marketed as incense or potpourri under different brand names such as spice. The potency of these drugs is variable and the range of adverse effects range from simple to severe and life threatening adverse effects such as myocardial infarction (MI), Ischemic cerebrovasular accident (ICVA) and seizures. Case report: we describe a 23 male patient who was admitted to the hospital several times suffering from severe side effects following spice abuse. In his first admission, he provided spice sample that we later confirmed to have at least two different synthetic cannabinoids. In his last admission for uncontrolled seizures he start feeling chest pain which was later diagnosed as acute MI. This appears to be the first case report where a spice abuser develops ICVA, uncontrolled seizures and MI at the same time with negative work up towards the etiology other than spice abuse. Discussion: the mechanism behind the possible proconvulsant effect of synthetic marijuana is not known, but it may be due to either their effects at the cannabinoids receptor or due to the absence of the anticonvulsant phytocannabinoids in spice products. Synthetic cannabinoids cause tachycardia and vasospasm due to their high affinity to cannabinoid receptors and this may lead to acute MI however the deep inhalation adopted by spice smokers increase carboxyhemoglobin concentrations and may also contribute to this atheromatous disease. Conclusion: given the patient negative history for thromboembolization, vasculitis, and hypercoagulable state, and the multiple admissions of this patient after smoking spice suggest an association. We hypothesize that synthetic marijuana or the herbs mixed with it might cause the ICVA, MI and seizures in his last admission. Based on extensive review of the literature this appears to be the first case report where a single spice abuser developed ICVA, uncontrolled seizures and MI with negative workup towards the etiology other than spice abuse. Screening for synthetic marijuana should be warranted in all teenagers with new onset seizure disorder. Furthermore, the possibility of MI and ICVA should be part of teenager's counseling sessions as by now it is increasingly reported in literature.