Carotid artery dissection and middle cerebral artery stroke following methamphetamine use

Methamphetamine use may be associated with increased risk of stroke in young adults. We describe two cases of carotid artery dissection and ispilateral middle cerebral artery (MCA) stroke following methamphetamine use. ### Patient 1. A 36-year-old right-handed woman had sudden onset of speech difficulty and right-sided weakness while eating lunch. She presented to the emergency department within 30 minutes. Her medical history was significant for migraine and oral contraceptive and methamphetamine use. She was smoking methamphetamine with some left neck pain over the preceding two nights. Her initial examination was remarkable for global aphasia, left gaze preference, and right hemiplegia without Horner syndrome. The NIH Stroke Scale (NIHSS) score was 21. The initial head CT was unremarkable. IV tissue plasminogen activator (tPA) was started within 80 minutes of symptom onset. She improved significantly with only moderate expressive aphasia and mild right hemiparesis 8 hours after tPA therapy. A follow-up diffusion-weighted MRI of the brain showed a small infarct in the …