Jamaican Susumber Berry Poisoning Mimicking Acute Stroke

Area of Science:

• Neurology
• Toxicology
• Emergency Medicine

Background:

• Stroke mimics are non-vascular conditions presenting as acute focal neurological deficits, often mimicking ischemic stroke.
• Susumber berry (SB) toxicity is an uncommon cause of stroke mimic, with limited documented cases.

Observation:

• This study reports four new cases of SB toxicity presenting as stroke mimics.
• A systematic review identified a total of 17 patients who ingested SB and experienced illness, including the four new cases.
• Common neurological manifestations included dysarthria (94%), unstable gait (94%), blurry vision (59%), and nystagmus/gaze deviation (47%).

Findings:

• SB toxicity can manifest with neurological symptoms resembling a stroke, particularly affecting posterior circulation.
• The mechanism may involve altered SB toxins affecting cholinergic receptors or inhibiting acetylcholinesterase.
• Most patients (82%) experienced rapid and complete recovery, though some required intensive care unit admission and intubation.

Implications:

• Consider toxicological etiologies, such as SB toxicity, in patients presenting with stroke-like symptoms, especially in emergency department settings with multiple simultaneous presentations.
• Understanding the potential for SB toxicity to mimic stroke is vital for accurate diagnosis and timely management.
• Further research into the specific toxins and mechanisms of SB toxicity can improve clinical recognition and treatment strategies.