Acute alcohol intoxication may cause delay in stroke treatment – case reports

Abstract

BackgroundThe signs and symptoms of acute alcohol intoxication resemble those of vertebrobasilar stroke. Due to their shared symptoms including double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication and vertebrobasilar stroke may pose a challenge. Moreover, if alcohol intoxication and stroke occur simultaneously, the signs and symptoms of stroke may be attributed to the effects of alcohol, leading to delayed stroke diagnosis and failure to perform reperfusion therapy.Case presentationsThree cases of alcohol intoxication and stroke are presented. The first patient (female, 50 years old) had dysarthria, nystagmus and trunk ataxia on admission. Her blood alcohol level was 2.3‰. The symptoms improved after forced diuresis, but 5.5 h later progression was observed, and the patient developed diplopia and dysphagia in addition to her initial symptoms. Angiography showed occlusion of the basilar artery. Intraarterial thrombolysis was performed. The second patient (male, 62 years old) developed diplopia, dysarthria and trunk ataxia after consuming 4-units of alcohol, and his symptoms were attributed to alcohol intoxication. Two hours later, neurological examination revealed dysphagia and mild right-sided hemiparesis, which questioned the causal relationship between the symptoms and alcohol consumption. Cerebral CT was negative, and intravenous thrombolysis was administered. The third patient (male, 55 years old) consumed 10 units of alcohol before falling asleep. Three hours later, his relatives tried to wake him up. He was unresponsive, which was attributed to alcohol intoxication. When he woke up 8 h later, right-sided hemiparesis and aphasia were observed, and cerebral CT already revealed irreversible ischemic changes.ConclusionsOur cases show that alcohol consumption may interfere with stroke diagnosis by mimicking the signs and symptoms of vertebrobasilar stroke. Moreover, attributing the symptoms of stroke to alcohol intoxication may delay stroke diagnosis resulting in failure of reperfusion therapy. Based on our observations we conclude that stroke should be considered in the case of worsening symptoms, dysphagia, hemiparesis and disproportionately severe signs that cannot be attributed to the amount of alcohol consumed. In the case of ambiguity, ambulance should be called, and if stroke cannot be excluded, specific therapy should be administered.

Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy

“…Alcohol consumption as a risk factor for stroke is known to follow a J-shaped curve, such that modest drinkers (< 15 g/d) have the lowest risk, and heavy drinkers (> 60 g/d) have the highest [42]. The signs and symptoms of acute alcohol intoxication are similar to those of vertebrobasilar stroke [43]. Due to similarities in symptoms such as double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication versus vertebrobasilar stroke may constitute a major diagnostic challenge.…”

“…Moreover, if alcohol intoxication and stroke occur concurrently, the signs and symptoms of stroke may be linked to the effects of alcohol, resulting in a delayed stroke diagnosis and failure to administer thrombolytic therapy. In the case of uncertainty, and if stroke cannot be excluded, thrombolytic therapy can be administered [43]. It is possible that the TIA-24 h-ischemic stroke patients with a history of alcohol abuse arrived at the hospital early, allowing stroke diagnosis to be established within the therapeutic time window.…”

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours and thrombolytic therapy

“…They demonstrated higher rates of dyslipidemia (52.8% vs 49.6%), HRT (2.3% vs 1.2%), migraine (3.4% vs 2.1%), obesity (51.1% vs 39.4%), and previous TIAs (10.8% vs. 8.1%), but were less likely to present with a previous stroke (21.9% vs 27.4%), PVD (6.0% vs 7.7%), and chronic renal disease (6.0% vs. 8.9%). The non-TIA <24 hours group was more likely to take cholesterol reducers (47.6% vs. 43 The ROC curve for the predictive power of the regression model is presented in Fig. 2.…”

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours and thrombolytic therapy

“…Alcohol consumption as a risk factor for stroke is known to follow a J-shaped curve, such that modest drinkers (<15g/d) have the lowest risk, and heavy drinkers (>60 g/d) have the highest [42]. The signs and symptoms of acute alcohol intoxication are similar to those of vertebrobasilar stroke [43]. Due to similarities in symptoms such as double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication versus vertebrobasilar stroke may constitute a major diagnostic challenge.…”

“…Moreover, if alcohol intoxication and stroke occur concurrently, the signs and symptoms of stroke may be linked to the effects of alcohol, resulting in a delayed stroke diagnosis and failure to administer thrombolytic therapy. In the case of uncertainty, and if stroke cannot be excluded, thrombolytic therapy can be administered [43]. It is possible that the TIA-24hr-ischemic stroke patients with a history of alcohol abuse arrived at the hospital early, allowing stroke diagnosis to be established within the therapeutic time window.…”