Methamphetamine is an addictive psychoactive stimulant and a known risk factor for stroke1. This illicit substance commonly leads to psychosis while under its influence as well as during periods of abstinence2,3. Methamphetamine-associated psychosis is unique in that periods of psychosis are prolonged, clinically challenging to treat, and lead to extended hospital length of stay (LOS)2,4. Little is known about the impact of methamphetamine use and the development of psychosis in patients with acute stroke. Whether concurrent methamphetamine use leads to prolonged psychosis in these patients and extends hospital LOS is unknown.

There is significant variability in methods used to perform neurological examination in poorlyresponsive patients. Inconsistent and poor inter-examiner reliability may lead to poor,consequential clinical decision-making and care. Noxious stimuli are routinely administered to elicit motoric responses to determine the depth of unresponsiveness in comatose patients. However, no study has tested the reliability of noxious stimuli delivery (NSD) method or quantified applied force that elicit motor responses in patients with coma.