Alcohol Intoxication as a Stroke Mimic and the Incidence of Acute Alcohol Intoxication in Stroke

Stroke Mimicking Symptoms and Consequences of Alcohol Intoxication: A Case Report

A 41-year-old Black male with a history of hypertension was involved in a car accident, after which he exhibited symptoms such as slow and incoherent speech, unstable gait, dizziness, drowsiness, slow thinking, and loss of strength in his limbs. Despite multiple negative alcohol tests, his symptoms mimicked those of acute alcohol intoxication. Upon presentation to the emergency room, physical examination and brain imaging revealed a right anterior thalamic ischemic infarction. He was discharged completely recovered after two days without sequelae. This case underscores the importance of considering stroke as a differential diagnosis in patients presenting with symptoms similar to alcohol intoxication, particularly in hypertensive individuals.

Clinician assessment of blood alcohol levels among emergency department patients

INTRODUCTION

Alcohol intoxication is a significant public health concern and is commonly seen among emergency department (ED) patients. This study was undertaken to identify the accuracy of clinician assessment of blood alcohol levels among emergency department patients.

METHODS

This prospective survey study was conducted at a Level 1 Trauma Center. Eligible study participants included physicians, nurses, and medical students involved in the care of patients who had BAC. Clinicians estimated the BAC prior to results availability.

RESULTS

Among 243 clinicians, the mean difference between the estimated BAC and actual BAC was 17.4 (95% CI: 4.7 to 30.1). Providers tended to overestimate the actual BAC level. The accuracy between roles (attendings, residents, RNs, students) was not significant (ANOVA p-value 0.90). Accuracy was not correlated with age of the patient (Pearson correlation 0.04, p-value 0.54). Accuracy was not associated with the patient's gender (Student's t-test two-tailed p-value 0.90), ethnicity (White versus all others, t-test p-value 0.31), nor insurance (government versus not government, t-test p-value 0.81). The average accuracy value was associated with mode of arrival (t-test p-value 0.003). The average accuracy for walk-in subjects was -14.9 (CI: -32.8 to 3.1) compared to ambulance arrivals 28.3 (CI: 12.7 to 44.0). Providers underestimated BAC for walk-ins and overestimated BAC for ambulance arrivals. Among 107 patients with a BAC of 0, clinician estimates ranged from 0 to 350. Clinicians estimated non-zero BAC levels in 17% of patients with BAC of 0 (N = 18).

CONCLUSIONS

Clinicians' estimates of BAC were often inaccurate, and often overestimated the BAC.