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Spontaneous bilateral quadriceps tendon rupture associated with norfloxacin

non-postpartum RCVS often have exposure to vasoactive substances, most commonly cannabis, serotonin recapture inhibitors and nasal decongestants. A case series of 48 cannabis-related strokes demonstrated 21% of the subjects had a radiological phenotype of reversible multifocal intracranial stenosis. Studies in rats showed active substances of cannabis delta8and delta9-tetrahydrocannabinol could have peripheral vasoconstriction effects. Up to 60% of patients with RCVS have abnormal cerebrospinal fluid results (mildly elevated white/red blood cell counts or elevated protein levels). Brain biopsy is generally not required for the diagnosis of RCVS. In our patient, we believe that the cannabis use contributed to the severe cerebral vasoconstriction and stroke, in combination with serotonergic polypharmacy. In addition, older adults smoking cannabis for recreational purposes could become more vulnerable to stroke and cardiovascular disease, as cannabis may interact with established cardiovascular risk factors. As up to one-third of Australians have used cannabis in their lifetime, clinicians should enquire about marijuana use prior to prescribing serotonergic drugs.