{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:56Z","timestamp":1787028656805,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated with acute undisclosed amphetamine abuse in a patient undergoing elective clipping of an unruptured middle cerebral artery (MCA) aneurysm. Methods: A 46-year-old male presented with a 3 mm broad-based unruptured aneurysm in the proximal M1 segment of the right MCA. The patient reported a history of illicit drug use, including intravenous consumption. Upon further questioning, he admitted to intermittent use of amphetamines, although he denied any recent use. Elective aneurysm clipping via a transsylvian approach was performed after multidisciplinary consensus. Postoperatively, the patient developed anisocoria, prompting an emergency CT with perfusion and angiography, showing significant findings. Further imaging revealed a bilateral superior cerebellar artery territory infarction. Given the patient\u2019s medical history, a toxicology screening later confirmed recent amphetamine use. Conclusions: This case highlights the need for preoperative evaluation, including routine toxicology screening, in patients with a history of substance abuse. Amphetamine use may present perioperative challenges and increase the risk of complications like vasospasm and stroke.<\/jats:p>","DOI":"10.3390\/jcm14093246","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T08:20:53Z","timestamp":1746606053000},"page":"3246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perioperative Stroke in MCA Aneurysm Surgery: The Hidden Risks of Amphetamine Use"],"prefix":"10.3390","volume":"14","author":[{"given":"Firat","family":"Taskaya","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Magdalena","family":"Swiatek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sifian","family":"Al-Hamid","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Reiser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3799-6194","authenticated-orcid":false,"given":"Roland","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Peter","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Behme","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Rashidi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-2411","authenticated-orcid":false,"given":"I. Erol","family":"Sandalcioglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belal","family":"Neyazi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1002\/jnr.23697","article-title":"Methamphetamine Induces the Release of Endothelin","volume":"94","author":"Seo","year":"2016","journal-title":"J. Neurosci. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1136\/jnnp-2017-316071","article-title":"Stroke and Methamphetamine Use in Young Adults: A Review","volume":"88","author":"Lappin","year":"2017","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1161\/ATVBAHA.119.312461","article-title":"Methamphetamine Use and Cardiovascular Disease","volume":"39","author":"Kevil","year":"2019","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1080\/02688690050175247","article-title":"Intracerebral Haemorrhage and Drug Abuse in Young Adults","volume":"14","author":"Mcevoy","year":"2000","journal-title":"Br. J. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s12028-008-9177-5","article-title":"Cerebrovascular Complications of Methamphetamine Abuse","volume":"10","author":"Ho","year":"2009","journal-title":"Neurocritical Care"},{"key":"ref_6","first-page":"e39331","article-title":"Substance Use Disorders (SUDs) and Risk of Cardiovascular Disease (CVD) and Cerebrovascular Disease (CeVD): Analysis of the Nationwide Inpatient Sample (NIS) Database","volume":"15","author":"Patel","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/jbcr\/irae014","article-title":"Inpatient Complications and Outcomes for Burn Patients Admitted With Methamphetamine Intoxication","volume":"45","author":"Stanton","year":"2024","journal-title":"J. Burn. Care Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101372","DOI":"10.1016\/j.artd.2024.101372","article-title":"Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications","volume":"27","author":"Kelly","year":"2024","journal-title":"Arthroplast. Today"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1136\/neurintsurg-2014-011161","article-title":"Methamphetamine Use Is an Independent Predictor of Poor Outcome after Aneurysmal Subarachnoid Hemorrhage","volume":"7","author":"Moon","year":"2015","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1213\/01.ane.0000221451.24482.11","article-title":"General Anesthesia and Chronic Amphetamine Use: Should the Drug Be Stopped Preoperatively?","volume":"103","author":"Fischer","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1161\/STROKEAHA.110.580647","article-title":"Hospital Mortality and Complications of Electively Clipped or Coiled Unruptured Intracranial Aneurysm","volume":"41","author":"Alshekhlee","year":"2010","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101376","DOI":"10.1016\/j.jvscit.2023.101376","article-title":"Methamphetamine Spasm in the Large Caliber Arteries-the Severity Is Likely Underestimated","volume":"10","author":"Bikk","year":"2024","journal-title":"J. Vasc. Surg. Cases Innov. Tech."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s10396-021-01096-0","article-title":"Association of Carotid Ultrasonography with Perioperative Stroke after Thoracic Aortic Aneurysm Treatment: A Retrospective Study","volume":"48","author":"Ito","year":"2021","journal-title":"J. Med. Ultrason."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.jocn.2017.06.030","article-title":"Perioperative Stroke after Cerebral Aneurysm Clipping: Risk Factors and Postoperative Impact","volume":"44","author":"Kashkoush","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1111\/j.1365-2044.1979.tb06250.x","article-title":"Acute Amphetamine Abuse. Problems during General Anaesthesia for Neurosurgery","volume":"34","author":"Michel","year":"1979","journal-title":"Anaesthesia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1007\/s10741-022-10261-7","article-title":"Cardiovascular Disease Associated with Methamphetamine Use: A Review","volume":"27","author":"Tobolski","year":"2022","journal-title":"Heart Fail. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s40263-014-0209-8","article-title":"Methamphetamine Psychosis: Epidemiology and Management","volume":"28","author":"Mooney","year":"2014","journal-title":"CNS Drugs"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e300876","DOI":"10.1136\/bmjment-2023-300876","article-title":"Psychosis with Use of Amphetamine Drugs, Methylphenidate and Atomoxetine in Adolescent and Adults","volume":"27","author":"Hamard","year":"2024","journal-title":"BMJ Ment. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1111\/eip.13547","article-title":"Diagnosis of Methamphetamine-Induced Psychotic Disorder: Findings of an Expert Consensus Panel","volume":"18","author":"Camfield","year":"2024","journal-title":"Early Interv. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.suc.2014.11.001","article-title":"Perioperative Management in the Patient with Substance Abuse","volume":"95","author":"Moran","year":"2015","journal-title":"Surg. Clin. North. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.bbr.2012.01.056","article-title":"Reversal of Cocaine Withdrawal-Induced Anxiety by Ondansetron, Buspirone and Propranolol","volume":"231","author":"Silva","year":"2012","journal-title":"Behav. Brain Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3246\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:28:41Z","timestamp":1760030921000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14093246"],"URL":"https:\/\/doi.org\/10.3390\/jcm14093246","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]}}}