Differential Diagnosis for 32-year-old Male Experiencing Eyes Rolling Up in Head After Hallucinogens and Alcohol

• Single Most Likely Diagnosis:

  • Intoxication or adverse reaction to delta-8 gummies and beer: The combination of delta-8 THC (a psychoactive compound found in cannabis) and alcohol can cause altered mental status, including disorientation, confusion, and abnormal physical reactions such as the eyes rolling back. This reaction is likely due to the synergistic effects of both substances on the central nervous system.

• Other Likely Diagnoses:

  • Cannabinoid Hyperemesis Syndrome (CHS): Although CHS is more commonly associated with long-term, heavy use of cannabis, it can present with cyclic vomiting and may include other symptoms like altered mental status. However, the eyes rolling back is not a typical presentation.
  • Alcohol Withdrawal: If the patient has a history of chronic alcohol use, withdrawal could be a consideration, especially if the symptoms occur after cessation or reduction of alcohol intake. However, the presence of delta-8 gummies complicates this picture.
  • Serotonin Syndrome: This is a condition that can occur with the use of certain medications or substances that affect serotonin levels in the body. While less likely given the context, the use of certain substances can precipitate serotonin syndrome, which includes symptoms like agitation, confusion, and changes in mental status.

• Do Not Miss Diagnoses:

  • Status Epilepticus: Although the description does not classically suggest seizure activity, any alteration in mental status or unusual physical movements should prompt consideration of seizure disorders, especially if there's a history of epilepsy or if other signs like tongue biting, incontinence, or post-ictal confusion are present.
  • Intracranial Hemorrhage or Stroke: These conditions can present with sudden onset of altered mental status and require immediate medical attention. While the context suggests substance-induced causes, it's crucial not to miss these potentially fatal conditions.
  • Meningitis or Encephalitis: Infections affecting the brain or meninges can cause altered mental status, confusion, and a variety of neurological symptoms. These conditions are medical emergencies.

• Rare Diagnoses:

  • Koro Syndrome: A rare culture-specific syndrome characterized by an intense anxiety that one's genitalia will recede into the body, possibly accompanied by a fear of death. It's extremely unlikely but could be considered in the differential for unusual presentations of anxiety or panic.
  • Psychogenic Nonepileptic Seizures (PNES): These are events that resemble epileptic seizures but are not caused by abnormal brain electrical activity. They are psychological in origin and can be triggered by stress, trauma, or other emotional factors. The presentation could potentially mimic the described symptoms if the patient has a history of psychological trauma or similar episodes.