Opium Overdose: “A Black Sheep in Acute Stroke Management”

Abstract

Submit Manuscript | http://medcraveonline.com unconsciousness while he was having his breakfast. A stroke code was announced and neurology was consulted. In his medical history he was Diabetic type 2 for 25 years and hypertensive for 20 years. He was taking oral hypoglycemics (Metformin, Gliclazide) and antihypertensives (Zestril) with adequate compliance. In his personal history he was also an oral opium addict for last 40 years. On examination he was a thin old gentleman not oriented in time, place and person. His Glasgow Comma Scale (GCS) for conscious status was E2M5V1=8/15. Vital signs were a blood pressure of 160/90mmHg, heart rate was 90/minute, and temperature of 98.6 Fahrenheit. Neurological exam revealed central gaze, doll’s eye and corneal reflexes were intact. Pupils were 2mm in size which were sluggish to direct and indirect light and nystagmus was not observed. Facial sensation to pain was intact assessed by grimace with a preserved facial symmetry. His tongue was central without any fasciculation. Uvula was central and gag reflex was present. Motor exam showed normal bulk and tone. Power in his limbs to painful stimulus was 3/5 in both upper limbs and 2/5 in both lower limbs approximately. Deep tendon reflexes were 2+ in upper limbs and 1+ in both lower limbs with bilateral flexor plantar responses. Sensory examination to pain was grossly adequate in all limbs. Neck was supple with no signs of meningeal irritation. Systemic examination was normal with no heart murmurs, abnormal breath sounds or visceromegaly. Laboratory workup is shown in Table 1. Computed tomography (CT-scan) of the brain acquired 1 hour 30 minutes into his symptoms showed mild cortical atrophy, normal sized ventricles and no intracranial bleed. He was being considered for intravenous thrombolysis for possibility of posterior circulation ischemic stroke. Other differential included opium overdose due to his chronic addiction. He was given 0.4mg of intravenous naloxone to which he responded within 1 minute and regained his consciousness. GCS improved to 15/15. Stroke code was called off. He was admitted for 24 hours during which he had restlessness and irritability. He was discharged after 2 days in stable condition with regular follow-ups in psychiatry and medicine clinics for long term rehabilitation for his chronic addiction.