We report a case of an 81 year old elderly man presented in the emergency department with a 1 hour history of sudden unconsciousness presented to a tertiary care hospital in Islamabad Pakistan. He was investigated on the lines of acute vascular event. He was being considered for intravenous thrombolysis for possibility of posterior circulation ischemic stroke. Other differential included opium overdose due to his chronic addiction. He was given 0.4mg of intravenous naloxone to which he responded within 1 minute and regained his consciousness. This case highlights the importance of considering opium overdose as a differential diagnosis in acute stroke care setting for neurologists and emergency physicians as it mimics acute stroke.
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