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Severe Stroke Leaves Teenager Blind and Brain-Damaged: Is Synthetic Marijuana to Blame?

Despite media focus on her use of synthetic weed, there is no hard evidence that smoking it caused Emily Bauer's stroke.
 
 
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Emily Bauer was a normal teenager until she started using synthetic marijuana, popularly sold as products called Spice and K2. Two weeks before the 17-year-old was hospitalized for suffering multiple strokes, she was experiencing migraines so severe she landed in the hospital, her parents told CNN.

Bauer was advised to undergo an MRI, but reportedly decided not to because she is claustrophobic. Her parents believe the severe headaches coincided with the onset of her synthetic marijuana use. Two weeks after the migraines started, Bauer took a nap and woke up in a “psychotic state” marked by hallucinations, violent outbursts and incontinence. Her stepfather, Tommy Brant, told CNN that they called 911 after realizing she had “done something [some drug]" and paramedics rushed her to the intensive care unit at a Houston-area hospital. Bauer was biting the guardrails, and the hospital put her in an induced coma. Four days later, an MRI revealed she had suffered several severe strokes. Her brain was so damaged and her prognosis so bleak, her parents decided to take her off life support. Three days later, they celebrated her birthday. Now blind and nearly paralyzed, Emily Bauer is trying to recover. 

Her father says his daughter’s tragic hospitalization has prompted him to begin a public service campaign about the dangers of synthetic marijuana. Through a non-profit named Synthetic Awareness for Emily (SAFE) they hope to educate “families as well as teachers and doctors, about the dangers and warning signs of synthetic marijuana use,” CNN said. 

“[W]e want to let kids and parents know about the warnings signs: migraines and withdrawal," Emily’s stepfather. "We all know the warning signs of alcohol and cocaine, but with this synthetic weed stuff, it's so new that nobody knows about this stuff. We want to let other parents know about this so they don't have to go what we've been going through."

A public service campaign about synthetic marijuana is surely warranted. A recent survey found that one in nine high school seniors have tried the drug, though we know very little about it. Synthetic cannabinoids found in products like what Emily Bauer smoked were invented to study cannabinoid receptors in the brain, which work to regulate appetite, nausea, mood, pain and inflammation. But they have since become popular and legal alternatives to marijuana use. Efforts at banning them, though well-intentioned, have led to more restrictions on research than in the market. Chemists can easily tweak a banned formula to produce a new, poorly understood but similar substance that is not illegal. Research on their effects on humans is minimal, at best.

There are many horror stories associated with synthetic marijuana use, ranging in severity from suicide to a teen’s strange drowning in knee-deep water. While a huge spike (from 300 to 3,000 in less than a year) in calls to poison control centers for the drug has been reported, it is unclear how many of them led to actual health diagnoses or were related to unwanted psychological effects.

It is possible that synthetic marijuana was not the sole, or even the main contributor, to Emily Bauer's stroke. Her stepfather indicates in his statement to CNN that her migraines could have been linked to use of or withdrawal from the drug. There is little evidence of withdrawal side effects after using synthetic marijuana, but any indication there might be is linked to the cessation of long-term use. Another possibility is that her migraines were not side-effects or symptoms of withdrawal, but warning signs of stroke. 

According to the Centers for Disease Control, stroke hospitalizations for young adults have risen in recent years, including a 30 percent increase in boys and girls ages 5 to 15. Migraines and the condition with which Bauer was diagnosed at the hospital -- vasculitis -- are linked to stroke in young adults. 

Melinda Campopiano, a medical officer with the Substance Abuse and Mental Health Services Administration, told CNN “she had never heard of a patient having a stroke” after using synthetic marijuana, but nonetheless went on to speculate about how synthetic marijuana could theoretically lead to stoke. 

“Generally, strokes are caused by restricted circulation, or a blood clot that blocks circulation. What we would be looking at with Spice, or K2, is the restrictive circulation model,” she said. Emily’s stepfather told CNN his daughter was diagnosed with vasculitis, an auto-immune disease that attacks and inflames blood vessels. In Emily’s case, blood vessels leading to her brain were constricted, restricting blood and oxygen flow. The causes of vasculitis are largely unkown, but it can lead to strokes like Emily Bauer’s.

A 2004 study on the causes and risk factors of stroke in 273 young people ages 16 to 49 found that the cause of stroke was unknown in about a quarter of cases. In 76 percent, however, a cardiovascular condition, including vasculitis, was indicated to be the cause. 

Migraine is also associated with stroke in young people, especially young women. A 2007 study found that women who experienced migraines with visual aura, or a transient disturbance in sight, were 1.5 times more likely to experience an ischemic stroke, particularly in those with no history of risk factors like hypertension, diabetes or myocardial infarction compared with women who had no migraine. Women who developed migraines within the previous year were six to ninte times more likely to experience stroke than those without a history of migraines. 

In a 2010 New York Times piece, David Dodick of Mayo Clinic wrote that while there is no evidence that migraine has a long-term effect on brain functioning, “[T]here is abundant evidence now that migraine sufferers with a history of aura are at a twofold increased risk of stroke. These strokes are of the ischemic type, which are caused when a blockage in a brain blood vessel results in a lack of blood supply to a region of the brain (in contrast to hemorrhagic strokes, which are due to a ruptured blood vessel).” An ischemic stroke is what Bauer suffered. 

While stroke among young people is uncommon and often mysterious, it is often tragic. As EmaxHealth recently reported, between 20 and 40 percent of strokes suffered by younger people are fatal, "and up to 80 percent experience permanent neurological deficits.”

Nonetheless, because strokes are unexpected in young adults, warning signs like sudden onset of severe headache, confusion and numbness often go untreated. 

“Although young stroke victims benefit the most from early treatment, it must be administered within four and a half hours,” Seemant Chaturvedi, a neurologist at Wayne State told the New York Times. “After 48 to 72 hours, there are no major interventions available to improve stroke outcome.”

While it is possible that Bauer's synthetic marijuana use was not a cause, but one factor among others that led to her stroke, the evidence suggesting this is limited to her parents' anecdotes. Placing so much emphasis on Bauer's use of synthetic marijuana as a sure cause of her debilitating stroke could be more distracting than focusing on what we do know: strokes among young adults are often fatal and appear to be rising in number.

 
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