Introduction: Alcohol intoxication can be a posterior circulation stroke mimic (SM) as they share symptoms such as dysarthria, gait disturbances and nystagmus. We describe alcohol intoxication as a SM and the frequency of acute alcohol intoxication among stroke patients. Methods: Prospective observational single-center study (2014-2017, HagaZiekenhuis, the Hague). In all patients > 16 years presenting as a possible acute stroke <6 hours of onset, blood ethanol was measured; > 0.1 blood alcohol level (BAC) was considered elevated. Results: In total 974 patients were included: 60 (6%) had elevated blood ethanol (mean: 1.3 BAC). In 180/974 (18%) a SM was diagnosed: 12 were due to alcohol intoxication (1% of total cohort, 7% of SM, mean ethanol level: 2.2 BAC). Half of these patients denied or downplayed their alcohol consumption. Stroke and concurrent alcohol intoxication occurred in 38/794 strokes (5%, mean ethanol level: 1.1 BAC). Compared to other stroke patients, these 38 patients presented more often after working hours (mean 6.38pm versus 2.23pm) and received alteplase and endovascular therapy less often (24% versus 43%, p=0.018 and 3% versus 10%, p=0.241, respectively). Conclusion: Of all patients presenting as a possible acute stroke, 6% also drank alcohol. 18% of the whole cohort was diagnosed with a SM. Acute alcohol intoxication as sole diagnosis was diagnosed in 1% of the total cohort and 7% of SM, half of these patients denied or downplayed their alcohol consumption. 5% of all stroke patients also drank alcohol and they were significantly less likely to receive alteplase or endovascular treatment.
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