Recreational drug use and RCVS: should toxicity screens become standard in RCVS diagnostics? (P2.284)

OBJECTIVE: Evaluate urine toxicology screen usage in RCVS patients BACKGROUND: Reversible Cerebral Vasoconstrictive Syndrome (RCVS) is characterized by a reversible segmental vasoconstriction of the intracranial vessels. RCVS has a variable presentation including headache, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, seizures, reversible posterior leukoencephalopathy, and illicit drugs such as marijuana, cocaine, and heroin have been suggested as etiologic factors. However, regardless of this association, urine drug screens are not commonly performed in the diagnostic workup of RCVS. This study evaluated confirmed cases of RCVS for prevalence of illicit drug use. DESIGN/METHODS: A retrospective chart review of 6 patients meeting the criteria for RCVS from our institution dated 2008-2014 was conducted to evaluate for appropriate drug screening. All patients had Primary Angiitis of the CNS ruled out with appropriate blood tests and CSF. RESULTS: All patients were treated with nimodipine on discharge and 2 patients received intra-arterial therapy with verapamil. All patients showed complete reversal of vasoconstriction on repeat angiograms. Two of the six patients received urine toxicology tests on admission for RCVS, and another two received urine toxicology tests on later admissions. Both patients who received this test on admission tested positive for marijuana, opiates, and benzodiazepines. Of the patients who underwent testing on later admissions, one tested positive for marijuana use and one tested negative. The duration of drug use in these patients was not known. CONCLUSIONS: As we transition into a new culture of researching marijuana derivatives to treat a multitude of neurologic diseases including pain syndromes, epilepsy, and multiple sclerosis we must also consider the vasoactive properties of the substance and potential vascular complications. This also raises the importance of improving drug screening in such patients with high suspicion of RCVS on admission and identifying high risk patients to prevent further vascular complications. Study Supported by: Disclosure: Dr. Mirchandani has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Wajnsztajn has nothing to disclose.