A young man developed delayed brain hemorrhage days after synthetic cannabis use

The patient initially presented with dyspnea, hemoptysis, and agitation after synthetic cannabinoid ("Bonsai") use. Initial brain CT was normal, but the patient developed delayed intracerebral hemorrhage in two locations (left frontal and right posterior parietal) during hospitalization. The delayed onset suggests SC-induced vascular damage or coagulopathy rather than direct acute injury.

Single case report with serial CT imaging documenting the progression from initial normal brain imaging to delayed bilateral intracerebral hemorrhage following synthetic cannabinoid use.

The delayed onset of brain hemorrhage after an initially normal CT scan is a critical clinical warning. Patients who appear to improve after synthetic cannabinoid exposure may still be at risk for life-threatening intracranial complications.

This case adds to the evidence that synthetic cannabinoids can cause bleeding in multiple organs, from lungs to brain, and that complications can be delayed. The mechanism may involve SC effects on coagulation or vascular integrity.

Single case report. Specific synthetic cannabinoid compound not identified. Other contributing factors (e.g., pre-existing vascular abnormalities) could not be fully excluded. The temporal relationship suggests but does not prove causation.