Code 420: A case series of accidental marijuana ingestion masquerading as acute stroke (P2.203)

Objective: NA Background: Marijuana is the most widely used illicit drug in the United States, with increasing prevalence of edible forms after legalization for recreational use in 8 states. Discreet, non-standard labels on marijuana food products pose public health risks for accidental ingestion and intoxication. Neurological manifestations of acute marijuana intoxication are not well described in the elderly. We report five cases of accidental marijuana ingestion in the elderly presenting as acute stroke codes. Design/Methods: A retrospective chart review was performed on administrative data from a comprehensive stroke center between January 2016 and October 2017. Cases were identified using ICD-10 codes for marijuana ingestion and procedure codes for CT head as a surrogate for neurological symptoms. The cases were analyzed for stroke code at onset, accidental ingestion or intoxication, demographic factors, presenting symptoms, neurological exam and work up. Results: Of 170 cases, 5% (N=8) presented as stroke codes, of which 63% (N=5) were due to accidental ingestion or intoxication. Age of these patients ranged from 59–90 years. Three patients unknowingly consumed an adult child’s edible marijuana, one was intubated for encephalopathy after first-time ingestion, and one presented after changing strains of edible marijuana. Initial NIH Stroke Scale ranged from 0–11. Common symptoms were dysarthria, numbness and mental status changes. Work up included CT head (N=5), MRI brain (N=3), EEG (N=1), and urine toxicology (N=5). All patients recovered to neurological baseline within 30 minutes to 48 hours. Conclusions: We report five cases of accidental marijuana ingestion in elderly patients presenting with acute neurological changes. This case series highlights the importance of considering marijuana intoxication in the differential diagnosis of acute stroke in the elderly, especially when symptoms do not localize well to one vascular territory. From a public health perspective, standard labels on edible marijuana products may prevent accidental ingestion. Disclosure: Dr Werbaneth has nothing to disclose. Dr. Goyal has nothing to disclose. Dr. Beriner has nothing to disclose. Dr. Vora has received research support from Bayer.