Abstract Number: PB0098
Meeting: ISTH 2020 Congress
Background: More than 5000 drug-related emergencies are attended annually in Spain.
Aims: We report a case of transitory hypofibrinogenemia in a young woman with SRVC secondary to cannabis overdose with an uncommon clinical presentation.
Methods: A 19-year-old female patient with episodes of recurrent vomiting presented a generalized tonic-clonic seizure followed by intense holocranial headache, and high blood pressure. CT scan and cranial MRI were performed visualizing acute ischemic bilateral frontoparietal subcortical lesions with vasogenic edema, as well as chronic hemorrhagic deposits in both posteroparietal regions. Infectious, autoimmune, porphyria and vasculitic etiologies were excluded. A Transcranial Doppler study showed segmental stenosis in both MCAs. A coagulation study revealed normal prothrombin, activated partial thromboplastin and low fibrinogen levels (Clauss method)). The patient confessed that in the last days she has been consumming high doses of cannabis during festival days (10 cigars per day).
Results: Given the suspicion of SRVC, an intracraneal arteriorgraphy was done, showing multiple vasospasms in segmental distal territories of both ACA and left PCA, with lesser involvement of MCA. Toxic in urine was positive for Cannabis. Prothrombin time-derived fibrinogen activity was 1.8 g/L and Clauss fibrinogen was 1,2 g/L. Finally, she was discharged asymptomatic in the third week after treatment with metilprednisolone, analgesics and levetiracetam, with fibrinogen normalization.
Conclusions: Hemorrhagic or ischemic stroke, aneurysmal subarachnoid hemorrhage and SRVC following high doses of cannabis consumption have been described. It is unclear whether have associated cannabis use in the regulation of inflammatory responses (inverse association between cannabis use and levels fibrinogen was described). Ensuring optimal levels of real fibrinogen, not derived, is important in these patients and especially if they go to fibrinolytic therapy. We highlight the unusual initial clinical presentation and fibrinogen decreased after taking Cannabis, one of the most consumed drugs by our teenagers.
To cite this abstract in AMA style:
Herrero S, Carvalho G, Hernández J, Merchán B. Temporary Hypofibrinogenemia in Reversible Cerebral Vasoconstriction Syndrome (SRVC) Associated a Cannabis Overdose [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/temporary-hypofibrinogenemia-in-reversible-cerebral-vasoconstriction-syndrome-srvc-associated-a-cannabis-overdose/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/temporary-hypofibrinogenemia-in-reversible-cerebral-vasoconstriction-syndrome-srvc-associated-a-cannabis-overdose/