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Título

ACUTE ISCHEMIC STROKE IN A YOUNG PATIENT CAUSED BY BINGE DRINKING: A CASE REPORT

RESUMO

CASE PRESENTATION: A previously healthy 40-year-old man from Recife, with a history of occasional binge drinking, presented sudden hemiparesis with hypoesthesia in the right side of the body after binge drinking. Associated with the condition, he presented transient gait incapacity for two minutes. He arrived at the emergency department in 2 hours with a NIHSS score of 2 points and a normal cranial CT scan, with no indication for thrombolysis. A double antiplatelet therapy was started with acetylsalicylic acid and clopidogrel. After 24 hours, the weakness in the right side remained, although of lesser intensity, evolving with hyperreflexia and superficial hypoesthesia in the entire right hemibody. The brain MRI revealed an area of ​​restriction to water diffusion in the left parietal cortico-subcortical region associated with signal hyperintensity on T2 and FLAIR, compatible with subacute ischemic vascular insult. Spectroscopy showed a reduction in the levels of N-Acetyl aspartate (neuronal marker) and a slight increase in the peak of lipids/ lactate with features suggestive of necrosis. Autoantibody research revealed ANA 1:640 (fine speckled). Serology for HIV, syphilis and hepatitis were non-reactive. Magnetic resonance angiography showed no evidence of atherosclerosis or other changes. New screening tests were performed for lupus, thrombophilia and vasculitis, including a new ANA, with normal results. The echocardiogram and 24h Holter did not show heart disease. The patient was discharged clinically stable after one month of hospital investigation with complete recovery of strength and sensitivity. DISCUSSION: Ischemic stroke mainly affects people over 65 years of age, with atherosclerosis as the main etiopathogenesis. Ischemic stroke in young individuals, below 45 years of age, should lead to the investigation of secondary causes such as infections, autoimmune diseases, genetic conditions, neoplasms, heart diseases and drug abuse, including alcohol and smoking. In this case, the patient started the symptoms within 24 hours after the binge drinking episode, with no other etiopathogenic causes being evidenced. FINAL COMMENTS: In the context of stroke in a young patient, an adequate investigation of secondary causes should be carried out. In this case, alcohol abuse were notorious as a possible cause of stroke in young people, and alcohol consumption should be considered in the primary and secondary prevention of stroke.

Palavras Chave

Acute ischemic Stroke, Binge drinking, Case report