Arokszallasi Tamas, Balogh Eszter, Csiba Laszlo, Fekete Istvan, Fekete Klara, Olah Laszlo
Department of Neurology, Faculty of Medicine, University of Debrecen, Moricz Zs. krt 22, Debrecen, 4032, Hungary.
Cerebrovascular and Neurodegenerative Research Group of the Hungarian Academy of Sciences, Moricz Zs. krt 22, Debrecen, 4032, Hungary.
BMC Neurol. 2019 Jan 29;19(1):14. doi: 10.1186/s12883-019-1241-6.
The 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.
Three 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.
Our 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.
急性酒精中毒的体征和症状与椎基底动脉卒中相似。由于它们有共同的症状，包括复视、眼球震颤、构音障碍和共济失调，酒精中毒与椎基底动脉卒中的鉴别诊断可能具有挑战性。此外，如果酒精中毒和卒中同时发生，卒中的体征和症状可能归因于酒精的影响，导致卒中诊断延迟以及未能进行再灌注治疗。
报告了三例酒精中毒合并卒中的病例。首例患者（女性，50岁）入院时出现构音障碍、眼球震颤和躯干共济失调。其血液酒精水平为2.3‰。强制利尿后症状有所改善，但5.5小时后病情进展，患者除原有症状外还出现了复视和吞咽困难。血管造影显示基底动脉闭塞。进行了动脉内溶栓治疗。第二例患者（男性，62岁）饮用4个单位酒精后出现复视、构音障碍和躯干共济失调，其症状被归因于酒精中毒。两小时后，神经系统检查发现吞咽困难和轻度右侧偏瘫，这对症状与饮酒之间的因果关系提出了质疑。脑部CT检查结果为阴性，遂给予静脉溶栓治疗。第三例患者（男性，55岁）在入睡之前饮用了10个单位酒精。三小时后，其亲属试图唤醒他。他没有反应，这被归因于酒精中毒。8小时后他醒来时，发现有右侧偏瘫和失语，脑部CT已显示出不可逆的缺血性改变。
我们的病例表明，饮酒可能通过模仿椎基底动脉卒中的体征和症状干扰卒中诊断。此外，将卒中症状归因于酒精中毒可能会延迟卒中诊断，导致再灌注治疗失败。根据我们的观察结果，我们得出结论，对于症状恶化、吞咽困难、偏瘫以及与饮酒量不相称的严重体征的情况，应考虑卒中的可能。在诊断不明确的情况下，应呼叫救护车，如果不能排除卒中，应给予特异性治疗。
