Neurologic Complications of Drug and Alcohol Use.
Clinical review identifies emerging neurologic complications from substance use, including potential cannabis-stroke associations, requiring neurologist awareness and intervention.
This review consolidates current knowledge about neurologic manifestations of substance use disorders, highlighting both established complications and emerging concerns. It demonstrates that neurologic presentations may be the first clinical encounter for patients with undiagnosed substance use disorders.
Neurologists increasingly serve as frontline clinicians for substance-related complications, particularly as novel psychoactive substances proliferate and cannabis legalization expands. Early recognition of substance-related neurologic syndromes creates intervention opportunities that could prevent progression and guide patients toward treatment.
| Study Type | Clinical Review |
| Population | Patients with substance use disorders and neurologic complications |
| Intervention | Clinical assessment and identification of neurologic syndromes |
| Comparator | Not applicable |
| Primary Outcome | Neurologic complications associated with various substances |
| Key Finding | Wide variety of opioid-related toxic encephalopathies identified, with some studies suggesting independent association between cannabis use and ischemic stroke |
| Journal | Continuum (Minneapolis, Minn.) |
| Year | 2024 |
Substance use disorders present with diverse neurologic manifestations that require systematic clinical recognition and assessment. The potential cannabis-stroke association warrants clinical attention in stroke evaluation, though causality remains to be established.
This review does not provide original research data or establish definitive causal relationships between substances and neurologic outcomes. The cannabis-stroke association mentioned reflects observational studies that cannot prove causation or control for all confounding variables.
The cannabis-stroke association requires cautious interpretation given the complexity of stroke risk factors and potential confounders in observational studies. Novel psychoactive substance complications may represent reporting bias toward severe cases rather than population-level risks.
Substance use disorders create diverse neurologic presentations that require clinical vigilance and systematic assessment approaches. While some associations like cannabis and stroke warrant attention in clinical evaluation, definitive causal relationships require more robust evidence.
Join the Conversation
Have a question about how this applies to your situation? Ask Dr. Caplan →
Want to discuss this topic with other patients and caregivers? Join the forum discussion →
Have thoughts on this? Share it:
FAQ
Is there a connection between cannabis use and stroke risk?
Some studies suggest an independent association between cannabis use and ischemic stroke. This emerging evidence is particularly relevant as cannabis legalization increases usage rates, requiring clinicians to consider cannabis as a potential stroke risk factor during patient evaluations.
What neurologic complications should I watch for with novel psychoactive substances?
Many novel psychoactive substances are unregulated and easily obtained online or in stores, with several associated with seizures and other neurologic complications. These substances pose particular challenges because their composition is often unknown and their effects unpredictable.
How has the opioid crisis affected neurologic presentations?
Substance use and overdose mortality rose sharply during COVID-19, largely due to fentanyl contamination. A wide variety of opioid-related toxic encephalopathies have been identified recently, expanding the spectrum of neurologic complications clinicians must recognize.
What role should neurologists play in addressing substance use disorders?
Neurologists frequently encounter severe complications of substance use and have a unique opportunity to guide patients toward treatment. Early identification and intervention for substance use disorders can prevent further neurologic complications and improve patient outcomes.
While recent data show modest decreases from peak pandemic levels, current overdose rates remain higher than pre-pandemic levels. The continued elevation in substance use creates ongoing risk for neurologic complications that clinicians must remain vigilant to identify and manage.
