Stroke phenotype in cannabis users among young adults with ischemic stroke


Incidence of ischemic stroke in young adults has been steadily increasing over the last 20 years. One hypothesis to explain this phenomenon is the increase in the use of illicit drugs, including cannabis. However, the mechanisms and the clinical presentation of ischemic stroke associated with cannabis use are unclear. The objective of this study was to describe the phenotype of ischemic stroke in cannabis users compared to non-users among a population of young adults with a first-ever ischemic stroke.


Patients aged 18 to 54 years consecutively hospitalized in a university department of neurology for a first-ever ischemic stroke from January 2017 to July 2021 were included. Drug use over the past year was assessed by a semi-structured interview and the stroke phenotype was described using the ASCOD classification.


A total of 691 patients, including 78/691 (11.3%) cannabis users were included. Cannabis use was independentely associated with potential A1 (OR = 3.30, 95% CI [1.45-7.5], p = 0.004) and uncertain A2 (OR = 13.1, 95% CI [2.89-59.4], p < 0.001) atherosclerotic cause of stroke after adjustment for vascular risk factors including tobacco and other drug use. Moreover, the association of atherosclerosis and cannabis use was significant for frequent, (OR = 3.13, IC 95% [1.07-8.6], p = 0.030), and daily cannabis use (OR = 4.43, IC 95% [1.40-13.4], p = 0.008), but not for occasional use.


We found a significant, independent and graded association of cannabis use with the atherosclerotic stroke phenotype.


atherosclerosis; cannabis; stroke; stroke in young adults.

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