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Brain Stem Infarction Caused by Proximal Internal Carotid Artery Stenosis in a Patient with a Persisting Primitive Trigeminal Artery

200 There is another argument suggesting that abuse of sympathomimetic drugs like khat is associated with cardiovascular events: the circadian rhythm of people suffering thrombotic events is different from that of normal controls. Studies such as ISIS-2 have consistently shown a morning peak in the incidence of acute myocardial infarction, which is related to an increased sympathetic outfl ow and circulating catecholamines at this time of the day [10] . Alkadi et al. [5] studied the occurrence of myocardial infarctions in khat users and found that 59% of myocardial infarctions developed between late afternoon and midnight. They found that the myocardial infarction incidence was increased three-fold [5] . Pharmacokinetic studies have shown a peak plasma concentration of cathinone 2.1–2.3 h after chewing [1, 11] . Present Case. Our patient developed recurrent large vessel cerebral disease. Both strokes occurred in the evening, after khat chewing. Alternative causes for stroke in young adults were carefully excluded. Apart from khat chewing, this young patient had no major risk factors for stroke, although he reported a familial history of severe arterial hypertension and neurological defi cit in family members who also regularly chewed khat. A genetic background that renders people vulnerable to khat-induced vascular changes, as suggested by Alkadi [5] , cannot be ruled out. After stopping khat chewing and taking aspirin regularly, no further cerebrovascular events occurred. We therefore conclude that our observation is highly suggestive of khat use being causally associated with ischaemic stroke. As we live in a multicultural society, we want to highlight this possible neurological manifestation of a social habit amongst immigrants.