Bilateral Basal Ganglia Lesions in Patients with Heroin Overdose: A Report of Two Cases

Abstract

The prevalence of opioid use has increased worldwide. Two-thirds of deaths caused by drug overdose are opioid-related. Individuals with opioid use may present with a variety of complications. The available history in unconscious patients is often insufficient, which may cause diagnostic difficulty and delayed management. We present two cases of 54-year-old and 25year-old male patients who were brought to our emergency department after being found unconscious at home, without any known preceding event. They were in a deep coma with a Glasgow coma score of 3/15. However, their brainstem reflexes were normal. Pinpoint pupils were observed bilaterally. Brain computed tomography (CT) demonstrated the presence of bilateral basal ganglia hypodensities in both patients, in addition to multiple hypodensities scattered in the cerebral hemispheres of one patient. Toxicology screening from both patients was positive for opioids. The patients were transferred to the intensive care unit for supportive management. One patient recovered completely, whereas the other remained in a vegetative state. The presence of bilateral basal ganglia lesions in brain CT in unconscious patients should alert the physician of opioid use disorder among these patients.

Opioid Overdose-Induced Diffusion Restriction in the Bilateral Basal Ganglia Revealed on Brain Imaging

“…Urinary toxicology screening was positive for extremely high concentrations of opioids and benzodiazepines. He went on to make an uneventful recovery with antidotes and supportive care [ 10 ].…”

Intoxications involving methoxyacetylfentanyl and U-47700: a study of 3 polydrug fatalities

“…carbon monoxide poisoning, heart disease, asphyxia, head trauma or drug overdose [28,29]. Bilateral necrosis at the globus pallidus was detected in association with oxycodone, methadone, heroin and morphine [28,[30][31][32], so that it was suggested as a diagnostic clue of opioid intoxication [30]. Due to poor vascularization, the globus pallidus appears especially susceptible to cerebral hypoxia-ischemia.…”

Fentanyl Overdose Presented with Unconsciousness, Hypoxia, Hypotension and Pinpoint Pupil Complicated by Acute Kidney Injury and Right Hemiparesis: A Rare Case Report

“…In this patient, abnormal brain CT findings was bilateral basal ganglia hypodensities and multiple hypodensities scattered in the cerebral hemispheres. Hassan recommended that the presence of bilateral basal ganglia lesions in brain CT in should alert the physician of opioid use disorder [6]. If bilateral basal ganglia lesions were found in brain CT, the etiology of unconscious patients would be opioid use disorder.…”

“…Features of cerebral infarction was detected in computed tomography of brain in patient with overdose of opioids and benzodiazepine and it was related with hypoxic brain injury [2]. Bilateral basal ganglia lesions were suggestive of narcotic overdose in unconscious patient [7]. of fentanyl was found beside him.…”