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.