Marijuana induced Reversible Cerebral Vasoconstriction Syndrome

Reversible cerebral vasoconstriction syndrome (RCVS) is a transient multifocal arterial vasoconstriction and dilatation. The term was proposed by a panel of experts1 as a unifying term for a variety of a syndromes characterized by cerebral vasospasms and resultant clinical manifestations of cerebral ischemia. These syndromes include Call–Fleming syndrome, drug-induced cerebral angiopathy, benign angiopathy of the CNS, postpartum cerebral angiopathy, and migrainous vasospasm. Drug abuse, especially cannabis, is an important etiologic factor for RCVS. It is one of the most widely used recreational substances in the world, considered by many consumers as a relatively safe drug with few significant side-effects.2 Cannabis contains 9-tetrahydrocannabinol (THC), which is rapidly absorbed when smoked, reaching a peak plasma concentration at 10–30 min, and is lipid soluble with a large volume of distribution.3 Cannabinoids bind to cannabinoid receptors, CB1 in the central nervous system and CB2 in the immune system.