Subarachnoid and intracerebral hemorrhage associated with necrotizing angiitis due to methamphetamine abuse--an autopsy case.

The authors report an autopsy case of methamphetamine-related intracranial hemorrhage and vasculitis. A 22-year-old female was comatose after an intravenous injection of an unknown dose of methamphetamine. Computed tomographic scans demonstrated massive subarachnoid hemorrhage and hematoma in the corpus callosum. Cerebral angiography revealed nonfilling of bilateral intracranial carotid arteries and extravasation of contrast medium from the right pericallosal artery which was visualized retrogradely via the vertebral artery. Postmortem studies found cerebral edema, subarachnoid, intraventricular, and intracerebral hemorrhage, and intracranial vasculitis, but no aneurysm or arteriovenous malformation. Necrosis of vessel walls with destruction of the smooth muscle layer, but no leukocytotic infiltration of the vessel walls were observed in all major cerebral arteries. The hemorrhage probably resulted from medial necrosis in the large intracerebral vessels, and a sudden drug-induced rise in blood pressure.