Cannabis-induced ischemic stroke involving the basilar and middle cerebral arteries in a 50-year-old man: a rare case report

Cannabis use has been increasingly associated with cerebrovascular events, though simultaneous large-vessel occlusions in both anterior and posterior circulations are rare. We report a case involving a 50-year-old male with no medical history who presented with decreased consciousness and left-sided hemiplegia. CT angiography imaging revealed acute occlusion of the right middle cerebral artery (MCA) and the basilar artery. Urine toxicology was positive for cannabis. Extensive cardiac and laboratory workups were unremarkable. The patient underwent successful mechanical thrombectomy, achieving full reperfusion (TICI 3) without complications. With no identifiable alternative cause and a history of chronic cannabis use, a diagnosis of cannabis-associated large-vessel ischemic stroke was made. To our knowledge, this is the first reported case of concurrent MCA and basilar artery occlusions in this context. This case highlights the need for increased awareness of cannabis as a potential risk factor for multi-territory ischemic stroke, particularly in patients without traditional vascular risk factors.