Technical comment

Letter to the editor concerning: “Alcohol-attributable mortality in Switzerland in 2011 – age-specific causes of death and impact of heavy versus non-heavy drinking”

Publication Date: 21.09.2014
Swiss Med Wkly. 2014;144:w14028

Josef G. Heckmann

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Halloween stroke syndrome

We read the study of Marmet et al. on alcohol-attributable mortality in Switzerland in 2011 published in this journal with great interest [1]. The authors clearly show that alcohol is a major cause of premature mortality in Switzerland. In young people alcohol related premature death is mainly caused by injuries and heavy drinking [1]. We wish to emphasise that, besides heavy drinking and chronic alcoholism, binge drinking specifically can have disastrous cerebrovascular consequences [2–4]. Sporting events and related social contexts, and holidays such as Halloween may be a cause for such binge drinking [5, 6]. Halloween in particular is increasingly developing as a festive season in Europe and thus as an occasion to have parties with excessive alcohol consumption [5]. By describing a case vignette, we wish to highlight the clinical condition of binge drinking and stroke, and propose the easily memorable term “Halloween stroke syndrome”.

A 31-year-old otherwise healthy male returned home from a Halloween party. Four hours later he was found with a left-sided hemiplegia, hemihypesthesia, gaze deviation to the right, left-sided hemianopia, and some confusion. The cranial computed tomography (CCT) did not show early ischaemic signs, but the CT-angiography revealed an occlusion of the proximal intracranial internal carotid artery. A bridging manoeuvre with intravenous thrombolysis (rtPA) and interventional recanalisation was decided, which were partially successful in the end. Previous to the stroke, the patient had drunk 8 Bavarian beers (each 500 ml) and 8 spirits of German schnapps (each 2cl) during a Halloween party. As a thorough stroke work up showed no other causes, a heavy binge-drinking-associated thromboembolic stroke in an otherwise healthy young adult was diagnosed.

Binge drinking has been identified as an independent risk factor for stroke [3]. It is defined as consuming ≥5 drinks within a few hours [7]. With a calculated total of 24 drinks on one occasion, our patient took nearly 5 times the amount of this critical binge drinking value. The pathophysiological factors – alcohol-triggered cardiac arrhythmia and embolism, elevated blood pressure, exaggerated sympathetic reaction, endothelial lesions, thrombosis of the proximal arteries, a general increase of blood clotting, cardiotoxicity, and metabolic disturbances such as hypomagnesaemia and hypokalaemia- have all been discussed [8]. Herewith the term “Halloween stroke syndrome” is proposed for this observed clinical condition of a dangerous binge drinking pattern and associated stroke which is a further significant risk in addition to injuries, motor vehicle fatalities, aggression and assault [7, 9]. It is not intended to introduce a new scientific term but to accentuate such a clinical context by using an easily memorable eponymous term. Interestingly in the context of “Halloween,” some other terms are already used such as “Halloween appendicitis”, “Halloween diarrhoea.” or “Halloween psychosis” [10–12].


Correspondence: Josef G. Heckmann MD, PhD, MME, Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, DE-84034 Landshut, Germany, josef.heckmann[at]klinikum-landshut.deReply to this Letter to the Editor:


  1 Marmet S, Rehm J, Gmel G, Frick H, Gmel G. Alcohol-attributable mortality in Switzerland in 2011 – age-specific causes of death and impact of heavy versus non-heavy drinking. Swiss Med Wkly. 2014;144:w13947.

  2 No authors listed. „Binge“ drinking and stroke. Lancet. 1983;2(8351):660–1.

  3 Sundell L, Salomaa V, Vartiainen E, Poikolainen K, Laatikainen T. Increased stroke risk is related to a binge drinking habit. Stroke. 2008;39:3179–84.

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  5 Tremblay PF, Graham K, Wells S, Harris R, Pulford R, Roberts SE. When do first-year college students drink most during the academic year? An internet-based study of daily and weekly drinking. J Am Coll Health. 2010;58:401–11.

  6 Bélanger RE, Ohl F, Berchtold A, Akre C, Suris JC. Social contexts of sport-practicing youth´s hazardous drinking. Swiss Med Wkly. 2012;142:w13526.

  7 Daeppen JB, Anex F, Leutwyler J, Gammeter R, Darioli R, Pécoud A. Binge drinking in 19 year old men. Swiss Med Wkly. 2005;135:179–83.

  8 O’Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ. Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proceed. 2014;89:382–93.

  9 Gmel G, Givel JC, Yersin B, Daeppen JB. Injury and repeated injury – what is the link with acute consumption, binge drinking and chronic heavy alcohol use? Swiss Med Wkly. 2007;137:642–48.

10 Conforti FP, Smego DR, Kazarian KK. Halloween appendicitis: pin perforation of the appendix. Conn Med. 1987;51:507.

11 Breitenbach RA. “Halloween diarrhea”. An unexpected trick of sorbitol-containing candy. Postgrad Med. 1992;92:63–6.

12 Schwartz J. Halloween psychosis. J Am Geriatr Soc. 1992;40:297.

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