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Case Reports
. 2018 May 31;13(3):747-752.
doi: 10.1016/j.radcr.2018.02.023. eCollection 2018 Jun.

Acute carotid thrombosis and ischemic stroke following overdose of the synthetic cannabinoid K2 in a previously healthy young adult male

Raihan Faroqui  1 , Peter Mena  1 , Allen R Wolfe  1 , Joseph Bibawy  1 , George A Visvikis  1 , Michael T Mantello  1
Affiliations
Case Reports

Acute carotid thrombosis and ischemic stroke following overdose of the synthetic cannabinoid K2 in a previously healthy young adult male

Raihan Faroqui et al. Radiol Case Rep. .

Abstract

With the popularity of synthetic cannabinoid street drugs such as "K2 and Spice," a number of serious neurologic adverse events are coming to light. This case is a 36-year-old African American man, with no significant medical history, who presented with extensive left cervical and intracranial internal carotid artery occlusion and subsequent ischemic stroke. The patient endorsed smoking K2-a synthetic cannabinoid (SC) with structural similarity to cannabis. The mechanism by which SC abuse induces a prothrombotic state leading to ischemic neurovascular sequelae is currently unclear, although a temporal association in the absence of other stroke risk factors suggests a causal relationship. Our case highlights the need for emergent neuroimaging upon suspected SC overdose. Practitioners should be vigilant in recognizing that ischemic stroke and unexplained neurologic deficit can arise after SC abuse, especially in younger populations with few stroke risk factors and who are prone to chronic cannabis use.

Keywords: CVA; K2; Stroke; Synthetic cannabinoid; Thrombosis.

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Figures

Fig. 1
Fig. 1
Axial computed tomography image demonstrates indistinct low density (red arrows) involving the left basal ganglia and external capsule, consistent with an acute ischemic infarct involving the left middle cerebral artery (MCA) vascular territory. Additionally, a hyperdense left MCA (yellow arrow) is present, concerning for a thrombotic event.
Fig. 2
Fig. 2
Serial axial images of computed tomography angiography of the neck at the level of the carotid bifurcation (A), as well as the cervical (B), lacerum (C), and cavernous (D) segments of the internal carotid arteries (ICAs) demonstrating left-sided central filling defects (yellow arrows), consistent with extensive acute left ICA thrombosis. The right ICA is normal in caliber and opacification.
Fig. 3
Fig. 3
Sagittal (A) and coronal (B) computed tomography reconstruction images demonstrate a large filling defect (yellow arrow) at the left carotid bifurcation which extends into the left internal carotid artery (ICA). The right ICA is normal in caliber and opacification.
Fig. 4
Fig. 4
Magnetic resonance (MR) images demonstrate hyperintense diffusion-weighted signal (A) with hypointense apparent diffusion coefficient signal (B) and hyperintense FLAIR signal (C) involving the left corona radiata, basal ganglia, and internal capsule, consistent with an acute left sided middle cerebral artery (MCA) territory infarct. Concomitant MR angiography (D) demonstrates minimal flow signal in the internal carotid artery at the skull base without visualization of flow signal in the left MCA distribution; supply to the left A2 segment is via the anterior communicating artery.
See this image and copyright information in PMC

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