Gabapentin Withdrawal Masquerading with Stroke-like Symptoms: A Case Report

Case Diagnosis: Gabapentin withdrawal can mimic stroke-like symptoms.

Case Description or Program Description: 71-year-old male, with history of low back pain, hypertension, and depression presented for stroke workup after one week of word finding difficulty, blurry vision, confusion, tinnitus, and balance impairment. His daughter also noted the patient started substituting words and had memory lapses.

In the emergency room stroke workup was negative for pathology. The patient was admitted for further work-up, which all was negative. Subsequently consulted the PM&R team discharge planning.

The PM&R team noted the patient’s course had worsened while hospitalized (5 days). He noted new headaches since hospitalized, that were worsening, now described as pounding throughout his head. He also noted acute photophobia, nausea, inability to sleep, and worsening visual changes as well.

After review of the patient’s chart, the PM&R team recognized the patients home gabapentin 600mg three times a day did not match his current dose. Upon further discussion with the patient, it was noted about 2 weeks prior to his hospitalization, the patient’s gabapentin was dropped to 200mg bid. The PM&R team became concerned of gabapentin withdrawal and recommended restarting gabapentin 300 mg three times daily with the plan to up-titrate to see if the patient’s symptoms resolve.

Setting: Tertiary Care Hospital

Assessment/Results: All the patients symptoms resolved after two days of restarting the gabapentin.

Discussion (relevance): To our knowledge, this is the first case, of gabapentin withdrawal mimicking signs of a stroke. People on chronic gabapentin will develop a physical dependence. In addition, the higher dosage and longer time on the medication can impact how to taper the medication. Symptoms of withdrawal may begin as quickly as 12 hours after ceasing the medication to 7 days. Gabapentin withdrawal is known to cause cognitive impairment, agitation, anxiety, slowed processing, new headaches, sweating, nausea, worsened pain, dizziness, and light sensitivity, all of which this patient experienced.

Conclusions: Serious consideration and appropriate taper management should be applied when discontinuing chronic medications, such as gabapentin, to avoid withdrawal symptoms. Acute withdrawal of gabapentin can mimic stroke-like symptoms and lead to unnecessary testing, hospitalization, health care dollar spending, and fear in patients and their families.