Lesson of the month: Oxycodone-induced leukoencephalopathy: a rare diagnosis

Jones, Eleanor; Umasankar, Udayaraj; Mallu, Habeeba; Hampton, Tim; Kulendran, Angela; Patel, Mehool

doi:10.7861/clinmed.2020-06500-0-0

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…The degree of deficit in patients depends on a multitude of factors, including dosages and length of exposure to toxins, level of toxicity, and patient history [10,11]. The use of heroin via snorting or smoking is a common cause of TLE, leading to the accumulation of opioids in the myelin sheath [12].…”

Section: Discussionmentioning

confidence: 99%

“…Cerebellar involvement, as seen with the patient's ataxia, is present in both heroin and oxycodone-induced encephalopathy. Heroin has an increased affinity for "mu" receptors, whereas oxycodone has an affinity for "kappa" receptors, both of which are found in the cerebellum [12]. Oxycodone specifically has a very high oral bioavailability, which allows for a high plasma concentration rather quickly.…”

Section: Discussionmentioning

confidence: 99%

“…Oxycodone specifically has a very high oral bioavailability, which allows for a high plasma concentration rather quickly. This can trigger side effects like cerebellar ataxia and cognitive changes within hours [12]. At present, most non-prescription opioids are laced with fentanyl or composed almost entirely of it.…”

Section: Discussionmentioning

confidence: 99%

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Toxic Leukoencephalopathy After “Chasing the Dragon” With a Non-Heroin Opioid

Agarwal,

Evans,

Mogallapu

et al. 2023

Cureus

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In the United States, the rate of opioid use increases each year. With this, users are engaging in more nontraditional methods of usage. "Chasing the dragon" is a term used to describe opioid inhalation, where the user heats the opioid and then inhales the smoke. While this method of usage is typically associated with a quicker high and fewer adverse effects, it can also lead to toxic leukoencephalopathy (TLE). TLE is defined as a structural alteration of the brain's white matter due to toxic exposure, such as heroin. A 57-year-old woman with a history of polysubstance abuse was admitted to the hospital after weeks of erratic behavior. At presentation, her urine drug screen was found to be positive for oxycodone (which was prescribed to her) and fentanyl. A brain MRI was eventually done, which showed a periventricular leukoencephalopathy characteristic of opioid inhalation. Traditionally, opioid-related TLE is due to heroin, and patients are found to have very dramatic motor issues. As this patient did not report a history of heroin use and did not present with significant motor deficits, this report highlights the need to maintain a level of suspicion for TLE. As levels of opioid use continue to rise, it is likely that many presentations like that of the patient outlined in this report will be seen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Toxic Leukoencephalopathy After “Chasing the Dragon” With a Non-Heroin Opioid

Agarwal,

Evans,

Mogallapu

et al. 2023

Cureus

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“…There was less affectation in the thalamic nucleus, corpus callosum, and watershed artery territories (middle cerebral artery with anterior and posterior artery branches), which suggests a role of a concomitant hypoxemic and unstable hemodynamic state that explains the distribution of the injury (similar to anoxic-ischemic states) in these regions (Fig. 2) [24][25][26][27][28][29][30] .…”

Section: Locations Of Neuroimaging Abnormalitiesmentioning

confidence: 99%

Movement disorders in opioid users observed in the social networks: a systematic review

Domínguez-García,

Hernández-Armesto,

ArguÓelles-González

et al. 2024

RMN

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The significance of social networks in medical education, particularly in the field of movement disorders, is immeasurable. The current trend revolves around the emergence of new-onset pandemics, such as the COVID-19 virus or the rising use of consumer opioids. This phenomenon is evident across social networks, where non-professional videos depicting individuals experiencing abnormal movement disorders, such as upright postures and gait issues, are widely shared. These videos often feature people living on the streets in various locations throughout the United States and other major cities worldwide. The phenomenology of movement disorders involves closely observing patients in the examination room to identify the clinical phenotype and distinguish between hyperkinetic and hypokinetic disorders. This initial step is crucial in the assessment of any movement disorder. Given the limited availability of literature discussing the clinical features of opioid users, our research strategy involved exploring articles in the PubMed database that met the PRISMA criteria for 2020. Specifically, we sought articles addressing the clinical phenomenology and pathophysiology related to movement disorders from 1980 to the present. Our objective was to investigate cases, propose potential theories regarding implicated mechanisms, and explore the role of opioids in the movement circuits within the basal ganglia.

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“…The diffuse cerebral and cerebellar injuries that have been reported after opioid intoxication exist on a spectrum with regard to the brain regions most involved. In contrast to the white matter injury, a lesser-reported gray matter–predominant insult can be seen in the setting of acute opioid intoxication, exhibiting variations within a spectrum of radiographic features characterized by cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome ( case 10-1 ), 22 whereas a mixed picture of cerebellar white matter and basal ganglia lesions has been described with oxycodone overdose 23 . It is the author’s opinion that any opioid, either prescription or nonpharmaceutical, via any route of administration, should be considered as a possible cause for these severe types of idiosyncratic diffuse brain injury, especially if exposure is excessive.…”

Section: Opioidsmentioning

confidence: 99%

Substance Use and the Nervous System

Stitt¹

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article informs and updates the practicing neurologist on the current landscape of known neurologic injuries linked to the use of illicit drugs, focusing on emerging agents. LATEST DEVELOPMENTS Synthetic opioids such as fentanyl and similar derivatives have exploded in prevalence, becoming the leading cause of overdose fatalities. The higher potency of synthetic opioids compared with semisynthetic and nonsynthetic opiates poses an increased risk for unintentional overdose when found as an adulterant in other illicit drug supplies such as heroin. Conversely, misinformation about the risk of symptomatic exposure to fentanyl through casual contact with the skin and ambient air has led to misdirected fear and stigma that threatens to impede valid harm-reduction measures for fentanyl users at risk of actual overdose. Finally, during the COVID-19 pandemic, overdose rates and deaths continued to climb, especially among those who use opioids and methamphetamine. ESSENTIAL POINTS A variety of potential neurologic effects and injuries can occur with illicit drug use owing to the diverse properties and mechanisms of action of the various classes. Many high-risk agents are not detected on standard drug screens, including so-called designer drugs, and the practicing neurologist is best served by recognizing the clinical features of the traditional toxidrome and other potential idiosyncratic effects of various illicit agents.

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Lesson of the month: Oxycodone-induced leukoencephalopathy: a rare diagnosis

Cited by 10 publications

References 19 publications

Toxic Leukoencephalopathy After “Chasing the Dragon” With a Non-Heroin Opioid

Toxic Leukoencephalopathy After “Chasing the Dragon” With a Non-Heroin Opioid

Movement disorders in opioid users observed in the social networks: a systematic review

Substance Use and the Nervous System

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