Perioperative Stroke in MCA Aneurysm Surgery: The Hidden Risks of Amphetamine Use

TL;DR

A patient with a history of amphetamine abuse developed a stroke after MCA aneurysm surgery, highlighting the risks of undetected drug use in neurosurgery.

Contribution

This case emphasizes the importance of toxicology screening in substance-abusing patients to prevent perioperative complications.

Findings

A patient with a history of amphetamine use developed a cerebellar infarction post-surgery.

Toxicology screening confirmed recent amphetamine use, linking it to increased stroke risk.

Undisclosed drug use can lead to vasospasm and stroke in neurosurgical settings.

Abstract

Background/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated with acute undisclosed amphetamine abuse in a patient undergoing elective clipping of an unruptured middle cerebral artery (MCA) aneurysm. Methods: A 46-year-old male presented with a 3 mm broad-based unruptured aneurysm in the proximal M1 segment of the right MCA. The patient reported a history of illicit drug use, including intravenous consumption. Upon further questioning, he admitted to intermittent use of amphetamines, although he denied any recent use. Elective aneurysm clipping via a transsylvian approach was performed after multidisciplinary consensus. Postoperatively, the patient developed anisocoria, prompting an emergency CT with perfusion and angiography, showing significant findings. Further imaging revealed a bilateral superior cerebellar artery territory infarction. Given the patient’s medical history, a toxicology screening later confirmed recent amphetamine use. Conclusions: This case highlights the need for preoperative evaluation, including routine toxicology screening, in patients with a history of substance abuse. Amphetamine use may present perioperative challenges and increase the risk of complications like vasospasm and stroke.

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