Stroke and Methamphetamine Use: A Systematic Review.

Background: Methamphetamine (MAP) use has been increasingly recognized as a potential risk factor for cerebrovascular disease; however, its association with different stroke subtypes and underlying mechanisms remains incompletely characterized. Objective: This study aims to systematically review the recent literature on the association between MAP use and stroke, including ischemic and hemorrhagic subtypes, as well as related vascular and cardiac pathology. Methods: A systematic search of studies published between 2020 and March 2026 was conducted following PRISMA guidelines. Data on study characteristics, participant demographics, MAP use, and outcomes were extracted, and risk of bias was assessed using the Newcastle-Ottawa Scale. Findings were summarized descriptively and synthesized narratively. Results: Eight (8) studies were included, primarily retrospective cohort studies. MAP-associated stroke patients were mostly males that are younger than non-users with fewer vascular risk factors and comorbidities. MAP use was associated with increased risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke. Aneurysm-related studies demonstrated higher aspect ratios and rupture at smaller sizes, suggesting increased vascular instability. MAP use was also linked to cardiomyopathy and reduced left ventricular ejection fraction, contributing to cardioembolic stroke risk, as well as a higher burden of cerebral small vessel disease. Despite these differences, clinical outcomes in some cohorts were comparable to those of non-MAP stroke populations. Conclusion: MAP use is associated with both hemorrhagic and ischemic stroke and is linked to alterations in vascular and cardiac pathology. These findings highlight a distinct clinical phenotype and underscore the need for prospective studies better to define risk, mechanisms, and long-term outcomes.