Abstract Background and aims Anabolic–androgenic steroids (AAS) may be an underestimated risk factor for stroke in young subjects. Methods A 30-year-old man came to emergency department for visual disturbs, aphasia and dysarthria for 36-48 hours. Although he was born by dystocial delivery, he had apparent normal neuropsychomotor development. He smoked 7-15 cigarettes/daily. He suffered from common migraine. A previous MRI showed an arachnoid cyst. Arterial hypertension crises were recorded. He referred abuse of enanthate testosterone, boldenone, methenolone, methandrostenolone for body building. Results Testosterone level was 13,86 and decreased to 5,88 ng/ml after one week. EEG recorded aspecific dysregulation. Hs troponin and BNP were normal, although altered repolarization was described at ECG. Mild left ventricular hypertrophy was present at transthoracic echocardiography. Rare supraventricular and ventricular extrasystoles were recorded at 24 hours Holter ECG. MRI showed areas of intense restricted signal in DWI/ADC and hyperintensity in T2/FLAIR in left precentral gyrus, insular and parietal regions. Conclusions Our clinical case highlights AAS abuse as a risk factor for stroke in young patients. In vitro studies showed direct negative effects on neuronal cultures. In vivo, vascular events are related to transient prothrombotic state with paradoxical embolization, because of increased blood viscosity and arterial hypertension. Impaired theory of mind, worse impulse inhibition and working memory, executive dysfunction and accelerated brain aging are reported in AAS abuse. Moreover, a plethora of other side effects may be observed, as hepato- and nephro-toxicity, suppression of endogenous testosterone and spermatogenesis, erectile dysfuncion, testicular atrophy, gynecomastia. Educational campaigns are needed. Conflict of interest Name of author: nothing to disclose
Fiori et al. (Fri,) studied this question.