Abstract Details

Title The Gummies Strike Again: An Emerging Stroke Mimic in New York City’s Unsuspecting Hotel Housekeepers

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-007

Objective To describe a series of stroke alerts triggered for acute neurological change secondary to inadvertent marijuana toxicity in hotel housekeepers.

Background Whilst accidental marijuana ingestion is well described in pediatrics, it is an infrequent cause for ED presentation amongst adults. With the legalization of marijuana, our hospital has witnessed an increase in posterior circulation stroke mimic presentations secondary to inadvertent marijuana ingestion.

Design/Methods We retrospectively reviewed the charts of patients who triggered stroke alerts for acute neurological symptoms that were ultimately attributed to inadvertent marijuana edible ingestion.

Results Five such women aged 55-79 presented to our hospital between May - September 2022 triggering a stroke alert. All women worked as housekeeping staff in hotels in the catchment area. Indication for stroke alert for all patients was acute onset dizziness concerning for posterior circulation stroke. Additional presenting symptoms included reduced level of arousal, recurrent emesis, dysarthria, anarthria, non-specific visual complaints and unsteadiness. Median NIHSS was 2. One patient displayed central pattern nystagmus and disabling truncal ataxia. Other patients exhibited dry mucous membranes, mydriasis, saccadic pursuits, and sustained clonus. Imaging and bloodwork were unremarkable for all patients. Urine toxicology was positive for THC in all patients, who denied prior THC use. One patient received tenecteplase and was admitted to NeuroICU for disabling vertigo and truncal ataxia. MRI brain was negative. Remaining patients did not receive thrombolysis due to non-disabling symptoms or suspected encephalopathy, and were admitted to the medical or neurological floor for observation. Patients recalled consuming unlabelled candy prior to symptom onset when specifically questioned about the positive toxicology screen.

Conclusions Inadvertent marijuana intoxication is increasingly presenting as a mimic for posterior circulation stroke in unknowing adult consumers. This appears to be an occupational hazard for housekeeping staff. Public health campaigns should encourage the proper storage and disposal of THC products.

Authors/Disclosures
Miryam Alkayyali, MD (Icahn School of Medicine at Mount Sinai) PRESENTER	Dr. Alkayyali has nothing to disclose.
Nbaa Masood, MD	Dr. Masood has nothing to disclose.
Louise M. McCarthy, MB BCh BAO (Mount Sinai Beth Israel)	Dr. McCarthy has nothing to disclose.
DeWitt D. Pyburn, MD (Mt Sinai Beth Israel)	Dr. Pyburn has nothing to disclose.

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