To determine the prevalence, hospital complications, and outcomes in spontaneous aneurysmal subarachnoid hemorrhage (aSAH) patients with cannabis use (CU).

CU is the most common type of recreational substance use in the United States and across the world and a known risk factor for developing aSAH, particularly in young adults. Among the few studies available, there is conflicting data regarding the possible impact of CU on hospital complications and outcomes in aSAH patients.

Retrospective chart review of 60 adults hospitalized with acute aSAH between January 2015 and December 2019 with confirmed urine drug screen (UDS) positive for CU. Demographics, hospital complications, and in-hospital mortality data were collected and analyzed.

Out of 537 patients admitted for acute aSAH, 476 had UDS collected on admission. Of those, 60 (12%) tested positive for cannabis on UDS. Subjects included 39 females (65%) and 21 males (35%) with an average age of 47±12 years. The majority of subjects identified as Black (55%), followed by White (25%) and Other (10%). Thirty nine subjects (65%) were current tobacco users. Hypertension was the most common comorbidity (55%). Average hospital length of stay was 16±12 days. Common in-hospital complications included symptomatic vasospasm (36%), hyponatremia that required intervention (28%), delayed cerebral ischemia (23%), and seizures (18%). Mechanical ventilation was needed in 25 patients (43%). The in-hospital mortality rate for subjects was 8%.

CU is common among individuals hospitalized for aSAH. Our subjects with aSAH and CU had similar demographics and rates of hospital complications compared to published studies examining complication and mortality rates in all patients with aSAH. Our cohort had a lower in-hospital mortality rate than expected based on published data. This study suggests that CU may not increase complications or worsen outcomes in patients with aSAH, however, additional studies are needed to further explain this relationship.