This article describes cerebrovascular disease associated with the therapeutic use of drugs. The clinical manifestations of drug-induced cerebrovascular disease are no different from those of cerebrovascular disease due to other causes, except for the link to the suspected drug and possible added adverse effects caused by that drug. The best known and most controversial of these links are hemorrhagic and thromboembolic complications that have been reported in patients on anticoagulant therapy. The only truly preventive measure is the avoidance of drugs suspected or known to be associated with cerebrovascular disease, particularly in patients with other risk factors. The prognosis varies according to the pathology of the drug-induced process. Most cases of vasculitis and vasospasm induced by drugs resolve when the offending medication is discontinued. The approach to management differs from that of cerebrovascular disease resulting from non-iatrogenic causes. For example, a patient with sudden onset of hemiplegia due to a drug is unlikely to have a thrombus occluding 1 of the main cerebral arteries and is, thus, unlikely to be a candidate for thrombolytic therapy.
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• Cerebrovascular disease can occur as an adverse reaction to drugs.
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• Clinical manifestations of drug-induced cerebrovascular disease are like those of the naturally occurring forms of the disease.
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• Recognition of a drug as the cause of disease is important for the management of cerebrovascular disease.
Historical note and terminology
This article describes cerebrovascular disease associated with the therapeutic use of drugs. This term is broad and covers cerebrovascular disease due to a variety of chemical and other therapeutic substances, as well exposure to various poisons. Classification of drug-induced cerebrovascular disease according to type and pathomechanism is shown in Table 1. Most of the cerebrovascular complications of drugs are not due to the direct effect of drugs on cerebral vasculature; they are more likely to be due to cardiovascular effects in general. Although cerebrovascular diseases have been recognized for a long time, their link to drugs has not been well recognized, except for hemorrhage as a complication of anticoagulant and thrombolytic therapies and stroke due to drug abuse.
Table 1. Classification of Drug-Induced Cerebrovascular Disease According to Type and Pathomechanism
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• Secondary to drug-induced disorders
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-- Cardiac arrhythmias
• Drug-induced reduction of cerebral blood flow
• Drug-induced hemorheological disturbances
• Drug-induced cerebral vasculitis
• Drug-induced vasospasm
• Drug-induced thromboembolic disease
• Drug-induced cerebral hemorrhage
• Drug-induced intrauterine and perinatal cerebral hemorrhage
Atrial fibrillation, which may produce stroke by arterial embolization, has been associated with several drugs, including the following: adenosine, dobutamine, milrinone, ondansetron, and anticancer agents (22).