# Seizure Following Zolpidem Withdrawal in a Patient Presenting as a Stroke Lysis Call: A Case Report

## TL;DR

A patient's seizure after stopping zolpidem was initially mistaken for a stroke, highlighting the need to consider drug withdrawal in stroke evaluations.

## Contribution

This case report highlights zolpidem withdrawal seizures as a potential stroke mimic and emphasizes the importance of medication history in stroke assessments.

## Key findings

- A 46-year-old woman presented with stroke-like symptoms due to zolpidem withdrawal.
- Initial neuroimaging was negative, but seizures occurred within 24 hours.
- The patient was successfully treated with a benzodiazepine taper.

## Abstract

Stroke lysis, or thrombolysis, is a time-sensitive intervention for acute ischemic stroke, but careful distinction from stroke mimics is essential to avoid inappropriate treatment. Zolpidem, a non-benzodiazepine hypnotic, is generally regarded as having low dependence potential; however, prolonged or high-dose use can result in withdrawal syndromes, including seizures. We report the case of a 46-year-old woman presenting with acute left upper limb weakness and facial sensory changes, initially managed as a stroke lysis call. She was outside the lysis window and had initial negative neuroimaging. Within 24 hours, she developed recurrent generalized seizures requiring intravenous lorazepam. Subsequent collateral history revealed chronic high-dose zolpidem use (50-200 mg daily), discontinued abruptly, confirming a diagnosis of zolpidem withdrawal seizure. The patient was successfully treated with a benzodiazepine taper and discharged with community mental health and substance misuse follow-up. This case emphasizes the importance of thorough medication history-taking in stroke evaluations, as withdrawal syndromes can closely mimic acute cerebrovascular events. It is also interesting to note that zolpidem can increase the risk of strokes.