Prolonged Neurological Depression, Bradycardia, and Gastroparesis Following Acute Oral Cannabinoid Ingestion: A Case...

Cannabis-containing edibles may be associated with clinically relevant intoxication, particularly when symptom onset is delayed and the clinical presentation is nonspecific. A 54-year-old man with treated dyslipidemia presented with worsening vertigo, dizziness, headache, slurred speech, psychomotor slowing, and generalized weakness after ingesting a cannabis-containing cookie. Symptoms began approximately three hours after ingestion and progressed to slurred speech and bradypsychia by 12 hours. On admission, he was awake but markedly bradykinetic and bradypsychic, with diffuse weakness and epigastric distension. Stroke workup, including brain CT, computed tomography angiography, and brain MRI, excluded intracranial hemorrhage, acute ischemia, and large-vessel occlusion. Chest CT was unremarkable, while abdominal CT showed marked gastric distension with retained gastric contents, compatible with acute gastric dysmotility/suspected gastroparesis, requiring Levin tube decompression. Cerebrospinal fluid studies and infectious testing were negative. Cardiac evaluation showed sinus bradycardia, with Holter monitoring revealing a mean heart rate of 48 beats/min and a nadir of 35 beats/min, without significant pauses or conduction abnormalities. Electroencephalography showed generalized slowing without epileptiform activity. Following consultation with the Poison Control Center, cannabinoid intoxication was considered the most likely diagnosis. The patient received supportive care with monitoring, intravenous fluids, and gastric decompression. His clinical condition improved from day three, and he was discharged fully recovered on day six. Cannabis-containing edible ingestion should be considered in the differential diagnosis of acute or subacute neurological symptoms when compatible exposure is reported. In this case, the presentation included bradypsychia, bradykinesia, slurred speech, bradycardia, and acute gastric dysmotility/suspected gastroparesis, initially raising concern for stroke or central nervous system infection. Careful diagnostic evaluation remains necessary to exclude serious alternative causes, but recognition of this possibility may help guide appropriate supportive management.