Abstract 3117: Role of Methamphetamine use on Severity of Initial Presentation and Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage

Abstract

Introduction: Methamphetamine is believed to have an effect on cerebral vasculature through its vasoactive properties. It has been linked to multiple medical complications, including subarachnoid hemorrhage in patients of a younger population. We hypothesized that methamphetamine use in patients with aneurysmal subarachnoid hemorrhage (aSAH) would be associated with more severe clinical presentations, adverse neurologic outcomes, and an increased incidence of vasospasm. Methods: We performed a retrospective review of patients who were admitted to the OHSU Neurosurgery service with aSAH between January 2005 and January 2011. The cases included patients who used methamphetamine, as documented by personal or family report and toxicology screening. We performed a multivariate analysis to examine the role of age, Hunt and Hess and Fisher grade on presentation, length of stay and Glascow outcome score. Results: An analysis of 374 patient charts included by criteria of having aSAH. Of these, 28 (7%) had a history of or were currently using methamphetamine as documented by a positive toxicology screen. On average the methamphetamine users were ten years younger (45.2 vs 55.9, p < 0.001). Despite the young age they had significantly higher Hunt and Hess grades (3 vs 2.5 and 2, p <0.001) than non-methamphetamine users and age-matched controls, respectively. Methamphetamine users had significantly higher rates of vasospasm (92.9% vs 71.1%, p= 0.015) than non-users, but there was no difference when compared to age-matched controls (92.9% vs 89.3%, p= 0.639). Methamphetamine users also had significantly lower Glascow outcome scores than age-matched non-user counterparts (3 vs 5, p<0.001) but not compared to the entire non-meth user group (3 vs 4, p=0.170). There was no difference in the length of stay (18 vs 16, p=0.431 and 18 vs 14, p= 0.250) for the methamphetamine user group verses both all non-users and age-matched controls. Conclusion: Methamphetamine use is associated with more severe clinical presentation and worse neurologic outcome compared to age-matched controls. Young patients have similar rates of vasospasm regardless of methamphetamine use.