The clinical impact of recent amphetamine exposure in aneurysmal subarachnoid hemorrhage patients

Jeffrey R Vitt; Roger C Cheng; Jason Chung; Travis Caton; Bo Zhou; Nerissa Ko; Karl Meisel; Edilberto Amorim

doi:10.3389/fneur.2024.1480401

The clinical impact of recent amphetamine exposure in aneurysmal subarachnoid hemorrhage patients

Front Neurol. 2025 Jan 7:15:1480401. doi: 10.3389/fneur.2024.1480401. eCollection 2024.

Authors

Jeffrey R Vitt¹, Roger C Cheng², Jason Chung³, Travis Caton⁴, Bo Zhou⁵, Nerissa Ko⁵, Karl Meisel⁵, Edilberto Amorim⁵

Affiliations

¹ Departments of Neurologic Surgery and Neurology, University of California, Davis, Sacramento, CA, United States.
² Department of Neurology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
³ Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States.
⁴ Department of Radiology, University of California, San Francisco, San Francisco, CA, United States.
⁵ Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.

Abstract

Background: Amphetamines possess sympathomimetic properties that can affect cerebral vasculature though conflicting reports exist about their effect on vasospasm risk and clinical outcomes in aneurysmal subarachnoid hemorrhage. This study aimed to characterize the impact of recent amphetamine use on vasospasm development in aneurysmal subarachnoid hemorrhage as well as neurological outcomes.

Methods: We retrospectively screened 441 consecutive patients admitted with a diagnosis of subarachnoid hemorrhage who underwent at least one cerebral digital subtraction angiogram. Patients were excluded if no urinary toxicology screen was performed within 24 h of admission, if there was a diagnosis of non-aneurysmal subarachnoid hemorrhage, or if ictus was greater than 72 h from hospital admission. Vasospasm characteristics were collected from digital subtraction angiography and transcranial Doppler studies.

Results: 129 patients were included and 24 tested positive for amphetamines on urine drug screen. No significant differences were found in respect to patient age, sex, or admission clinical severity scales (Hunt-Hess and modified Fisher) based on amphetamine use. There was no difference in the severity of vasospasm or time to peak severity based on recent amphetamine use. A trend toward more isolated posterior circulation vasospasm was observed in the amphetamine present group (16.7% vs. 4.8%, p = 0.06), while there was higher incidence of anterior circulation vasospasm in the amphetamine absent group (79.2% vs. 94.3%, p = 0.03). There was no difference in delayed cerebral ischemia incidence, length of hospital stay, need for ventriculoperitoneal shunt placement, functional outcome at discharge or hospital mortality based on amphetamine use.

Interpretation: Recent amphetamine use was not associated with worse vasospasm severity or delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage patients. Further investigations about localized effects in the posterior circulation and impact on long-term functional outcomes are warranted.

Keywords: amphetamines; aneurysmal subarachnoid hemorrhage; cerebral angiography; transcranial doppler ultrasound; vasospasm.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by NIH (1K02NS060892), Howard Hughes Medical Institute (P0012375), and American Heart Association (P0055826) [NK–PI]. Edilberto Amorim was supported during this research by the NIH (1K23NS119794), Hellman Fellows Fund, Regents of the University of California (Resource Allocation Program), CURE Epilepsy Foundation (Taking Flight Award), Weil-Society of Critical Care Medicine Research Grant, Zoll Foundation Grant, American Heart Association (20CDA35310297 and Harold Amos Medical Faculty Development Program).