Delayed Intracerebral Hemorrhage after Synthetic Cannabis (Bonsai) Abuse; Case Report and Literature Review

Bonsai is a synthetic cannabinoid (SC) substance which can cause lung toxicity with chronic use. However,there are few case reports in literature related to bonsai-induced intracerebral hemorrhage in literature. A 25-year-old man presented at the Emergency Room (ER) with dyspnea,hemoptysis,agitation subsequent to bonsai use. He became unconscious in ER,was then intubated,admitted to the intensive care unit (ICU). The cranial computed tomography (CT) scan was non-specific,a thoracic CT scan revealed consolidation,the appearance of “ground-glass” in the lung,and therefore,development of diffuse alveolar hemorrhage was considered. The patient recovered consciousness on the second day of hospitalization,was extubated. During follow-up,he lost consciousness once again,on the cranial CT images,hemorrhage areas located in the left frontal,right posterior parietal regions were observed. Nevertheless,no surgical intervention was considered. The patient recovered consciousness three weeks after the second intubation,was transferred to the psychiatry clinic. In patients with synthetic cannabinoid substance abuse,life-threatening intracranial complications in the early and,or late phase should be kept in mind in addition to respiratory,systemic complications in the acute phase.