Occasional alcohol consumption is often perceived as harmless, especially among young, otherwise healthy individuals. However, this case highlights how binge drinking can precipitate a serious and potentially life-threatening neurological emergency, even in the absence of traditional risk factors.
Case Presentation
A young software professional from a Tier-1 city initially presented to a local clinic with headache, body ache, and a febrile sensation. Routine investigations were performed, and a Widal test returned positive. He was treated symptomatically, including an intramuscular injection for body pain, and advised rest.
Soon after, he travelled to his hometown, Hubli, for recovery. When he presented for further consultation, his parents were visibly anxious. They repeatedly pointed to his right shoulder and arm, firmly convinced that the earlier injection had caused some damage.
Initial Clinical Assessment
On first interaction, the patient appeared:
- Conscious and cooperative
- Fluent in speech
- Clear in articulation
- Intact in comprehension
At first glance, there were no obvious neurological deficits.
However, when asked simple questions—such as details about his occupation—he was unable to answer. He struggled to name common objects and could not clearly explain what was troubling him.
This discrepancy between fluent speech and impaired expression raised concern for a higher cortical dysfunction, rather than a peripheral or post-injection complication.
Neurological Examination: The Subtle Clues
A detailed neurological examination was conducted, revealing:
Mild weakness in the right upper limb
Difficulty expressing the weakness verbally
Importantly, the patient was attempting to communicate this weakness but was unable to do so because of anomia (naming difficulty).
The combination of:
Subtle language impairment
Focal limb weakness
strongly suggested a cerebrovascular event, despite the absence of dramatic stroke signs.
Imaging and Diagnosis
An urgent MRI brain was advised.
Imaging revealed findings suggestive of cerebral (cortical) venous thrombosis, which was subsequently confirmed on MR venography.
The final diagnosis was:
Cerebral Venous Thrombosis (CVT)
Uncovering the Trigger
On further, careful history-taking, the patient disclosed a binge drinking episode approximately four days prior to symptom onset. He had consumed a large quantity of alcohol over a short period.
Binge alcohol consumption is a known trigger for venous thrombosis due to:
Dehydration
Hemoconcentration
Alcohol-induced alterations in coagulation pathways
These mechanisms significantly increase the risk of cerebral venous thrombosis, even in young individuals.
Treatment and Outcome
The patient was:
Admitted immediately
Started on anticoagulant therapy (blood thinners)
Over the next few days, his recovery was remarkable:
Speech normalized
Naming difficulty resolved completely
Right arm strength improved significantly
Both the patient and his family were relieved to understand that the symptoms were neurological in origin and not related to the intramuscular injection.
He was discharged with:
A defined course of anticoagulation
Advice for strict lifestyle modification
Complete abstinence from binge alcohol consumption
Further evaluation was planned to rule out any underlying clotting disorders.
Key Learning Points
1. Binge Drinking Is Never Safe
Even a single episode can trigger serious complications such as:
Cerebral venous thrombosis
Stroke
Cardiac rhythm disturbances
2. Speech Changes Can Be Subtle
Normal fluency does not rule out neurological disease.
Warning signs include:
Naming difficulty
Inability to express thoughts
Word-finding problems
These may be early indicators of stroke.
3. Weakness May Be Misinterpreted
Patients may struggle to describe limb weakness clearly.
Careful neurological examination is essential—especially when complaints seem vague.
4. Headache With Neurological Symptoms Is an Emergency
Headache associated with:
Speech changes
Limb weakness
Altered behavior
must never be ignored and requires urgent evaluation.
5. Not All Strokes Require Lifelong Medication
In CVT due to reversible risk factors (such as dehydration or binge alcohol), anticoagulation may be temporary, based on individual risk assessment.
6. Risk-Factor Modification Is Powerful Medicine
Avoiding binge alcohol, maintaining hydration, and adopting healthy lifestyle habits can allow patients to:
Recover fully
Prevent recurrence
Lead a normal life
Conclusion
This case underscores how binge alcohol consumption—often dismissed as a harmless weekend indulgence—can precipitate a life-threatening neurological emergency.
It also highlights the importance of careful clinical observation, where subtle language abnormalities and mild limb weakness provided the crucial clues to diagnosis.
Early recognition, prompt imaging, and timely treatment can lead to dramatic recovery and excellent long-term outcomes.