The Epidemiology of Reversible Cerebral Vasoconstriction Syndrome in Patients at a Colorado Comprehensive Stroke Center

Abstract

Objective—Vasoactive substances, including marijuana, are known precipitating factors of reversible cerebral vasoconstriction syndrome (RCVS). Our objective was to describe the demographics, suspected etiology, and outcomes of RCVS patients, with specific interest in examining the subset of patients who used
marijuana prior to the onset of RCVS.
Methods—We identified and described consecutive RCVS cases treated at a regional, high-volume Comprehensive Stroke Center in Colorado (2012–2015). Univariate analyses were performed to examine the
associations between the characteristics and outcomes (stroke and discharge disposition) of the RCVS
patients by precipitating factors. We compared patients who used marijuana to those who did not and
patients who used marijuana to patients who used vasoactive substances aside from marijuana.
Results—Forty patients had RCVS. Sixteen (40%) cases were deemed idiopathic and 24 (60%) were secondary to a suspected trigger. Vasoactive substances were the most common suspected trigger (n = 18/24,
75%), 6 (33%) of which were marijuana. Approximately 80% of patients experienced an intracranial hemorrhage, 20% had an ischemic stroke, and yet 78% were discharged home. Patients with RCVS secondary
to marijuana were more often male (p = 0.05) and younger (p = 0.02) compared to those who did not use
marijuana; no differences were observed in the outcomes. These findings were consistent when examining
marijuana versus other vasoactive substances.
Conclusion—This study suggests there are demographic differences between patients with RCVS triggered by marijuana compared to the typical RCVS patient. As more states legalize marijuana, medical conditions such as RCVS and their association with marijuana warrants further study and awareness.