Neurological Manifestations Associated with Synthetic Cannabinoid Use- A Case Series

Marwa Elnazeir1, *0000-0003-2697-0980, Siddharth Narayanan2, *0000-0002-5553-3221, Pradeepthi Badugu30000-0002-6396-8030, Abid Hussain20000-0002-6172-9407, Cody B Stephens20000-0001-7730-3665, Riwaj Bhagat10000-0002-8783-4440, Christopher M Jones2, Wei Liu10000-0001-6912-2194, Alexi R Hernandez1, Kerri S Remmel1, Adriana E Palade1, *0000-0002-4828-8459
1 Department of Neurology, University of Louisville, 500 South Preston Street, Louisville, KY, 40202, USA
2 Department of Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY, 40202, USA
3 Department of Medicine, University of Louisville, 501 East Broadway, Suite 100 Louisville, KY 40202, USA



Synthetic Cannabinoid (SC) use has emerged as a growing public health threat in the United States. Several unexpected cases, presenting with a constellation of unrelated symptoms, but all having toxicity linked to SC use, have been reported in the last decade (2010-2019).


We report a cluster of several independent cases where patients were admitted having different neurological manifestations. Extensive and expensive work-ups were performed. Upon further inspection, extended toxicology screens were found to be positive for SC metabolites.


It is alarming to observe that several reports highlight an increase in the varied and significant morbidity associated after SC use. Various SC compositions have been synthesized and distributed, with new molecules being generated at a staggering rate leading to unexpected manifestations.


Young people are the most frequent users owing to its recreational effects, its easy accessibility, lower cost and difficulty in being detected in the urine by routine drug screens. From a hospital quality improvement perspective, efforts to characterize the presence of newly generated SC molecules and establish more accessible in-house screening methods will be a starting step in reducing the associated cost-burden. This will also minimize the unnecessary invasive procedures performed on a specific patient. From a socioeconomic viewpoint, solid and systematic crosstalk with increased recognition and reporting mechanism between the healthcare staff and public health personnel is strongly warranted to support state and federal regulatory efforts in combating this ongoing SC epidemic.

Keywords: Stroke, Synthetic cannabinoids, Drug toxicity screens, Urine test, Seizures, Cardiovascular.

Abstract Information

Identifiers and Pagination:

Year: 2020
Volume: 14
Publisher Item Identifier: EA-TONEUJ-2020-14

Article History:

Electronic publication date: 20/7/2020
Collection year: 2020

© 2020 Elnazeir, Narayanan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Neurology, University of Louisville, 500 South Preston Street, Louisville, KY, 40202, USA; Tel: +1.502.588.4800; E-mail: