Crozet Annals of Medicine: Re-gifting

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Grandpa was having a stroke on Christmas Eve. He was driving home from his daughter’s house after babysitting his grandkids while his daughter did some last minute shopping. When his daughter got home grandma and grandpa said good-bye to her and the grandkids and left for their home. Soon grandma noticed the car swerving and asked grandpa what was wrong. He said nothing, just shook his head, eased the car to the side of the road and closed his eyes. When he tried to speak his words were slurred and when he opened his eyes they just roamed around aimlessly. He had a terrible headache. Grandma called 911 on her cellphone and help quickly arrived.

The medics called in their report.

“Sixty-seven-year-old male sudden onset slurred speech, inability to move his extremities, altered level of consciousness.”

On arrival to the hospital a stroke alert was called and the neurology team mobilized quickly. His exam was challenging because he could not seem to understand the commands of the neurologist. When asked what wrong all he could say was “I can’t remember anything” He perseverated on this, repeating it multiple times. He did seem to be able to move everything, although randomly, and he had no obvious facial droop. His speech was garbled but understandable.

Strokes can present in many ways but for complex reasons it would be very rare to have the chief neurological involvement be amnesia. This happens in less than 0.2 percent of all strokes. An alternative diagnosis, Transient Global Amnesia (discussed in a previous Crozet Annals column) was considered but rejected because of the slurred speech and roving eye movements.

It was a puzzle. He got a rapid CT scan of his brain, which showed that, thankfully, he wasn’t having a brain bleed.

We made arrangements to admit him to the neurology service to continue the search for the cause of his symptoms. It was then that his daughter arrived, took a look at her father and motioned us out of the room.

“Do you know what’s wrong with my dad?”

“No, we are still trying to figure it out. He seems very confused. He is going to be admitted to the hospital and get more studies.”

“I think I know what’s wrong with him” she said. We all looked at her quizzically.

“My boyfriend is visiting from Colorado and he brought me some brownies as a Christmas gift. Special brownies. One is missing. I think my dad ate it.”

I asked her about her children but she assured me the brownies were out of reach of the children.

Questioning her father, who was showing signs of improvement already, he confirmed that he had unsuspectingly eaten a brownie and it was delicious. The knowing looks on the faces of the interns in the room clued grandma and grandpa into the composition of the brownies and the reason for grandpa’s strange behavior. Grandpa was stoned on Christmas Eve. The brownies were made with butter laced with marijuana extract.

Colorado legalized marijuana in 2012 and since then has seen a modest but noticeable uptick in ER visits for marijuana-related problems. Most are for anxiety and paranoia, and other mental health issues. The most severe seem to be related to the edible forms of the drug and not the smoked form. Many of the visits follow the pattern of my patient, people who inadvertently ingest someone else’s edible marijuana product. At least that is what they say.

So we warned the mom about the dangers of these brownies being left out, especially to her kids, and discharged grandpa to recover at home where he had an ample supply of Cheetos.

And I recommended fruitcake as a safer holiday edible to exchange and inevitably re-gift.

Happy Holidays, Crozet!

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