1524 - From Trip to Triage: A Psychedelic Retreat Takes a Serious Turn with a Brain Hemorrhage

Case Diagnosis: Large R frontal hemorrhage w/ midline shift and SAH 2/2 psychedelic use

Case Description: A 78-year-old female with PMH of HLD, hypothyroid was admitted to the hospital for a large R frontal hemorrhage w/ midline shift and subarachnoid hemorrhage. While admitted to Burke for rehabilitation, the patient’s rehabilitation course was complicated by slow processing speed and poor attention. Patient also had visual hallucinations, which ultimately resolved with initiation of amantadine.
History given by the daughter revealed that the patient was attending a retreat, where psychedelic drugs were offered to attendees, who were obtaining education credits as psychologists. The patient started exhibiting symptoms at 3AM with delusions but the facility only called the daughter at 7AM. The daughter insisted that the facility send the patient to the hospital at 9AM.

Discussions: The patient's stroke, which occurred after ingesting psychedelics, may be linked to the cardiovascular and neurological effects of psychedelics. Psychedelics, such as 3,4-methylenedioxymethamphetamine (MDMA), have been associated with vasoconstriction, hypertensive crises, and vasculitis, which can contribute to both ischemic and hemorrhagic strokes(1). Psychedelics influence serotonergic pathways, which regulate vascular tone, causing vasospasms(2). Additionally, the neuroinflammatory effects of psychedelics and their influence on cerebral blood flow can raise the risk for cerebrovascular events(3).
However, psychedelics also show potential benefits in neurorehabilitation following brain injuries. Studies indicate that these substances may enhance neuroplasticity, neurogenesis, and cognitive flexibility, contributing to stroke recovery by enhancing brain adaptation and emotional resilience (3). The modulation of brain complexity and reduction of neuroinflammation are factors that could aid recovery. Despite potential benefits, the risks necessitate careful consideration, especially in individuals with preexisting cardiovascular conditions.

Conclusions: The patient’s stroke after psychedelic use highlights the dual nature of psychedelics. While these substances may contribute to stroke onset through vasoconstriction and hypertension, they also hold potential for enhancing neuroplasticity and aiding recovery of strokes.