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

Abstract

Opioid misuse and addiction have led to an opioid epidemic in the United States, with widespread effects on the healthcare system. Opioid-induced cardiovascular morbidity and mortality effects have been extensively described in past literature; however, neurological effects have been described less frequently.Here, we describe a case of a female patient who presented to our center after being found unresponsive with magnetic resonance imaging (MRI), revealing bilateral basal ganglia diffuse restriction hyperintensities secondary to a diagnosis of opioid overdose.Opioid overdose-induced bilateral basal ganglia diffusion restriction has only been described infrequently in the literature. Recognizing the associated imaging findings as a potential consequence of opioid overdose is important to avoid unnecessary workups for ischemic stroke.

Heroin-induced leukoencephalopathy: Chasing the imaging findings

“…The differential diagnosis of HLE includes hypoxic ischemic encephalopathy, CHANTER syndrome, Pediatric Opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome, and Opioid-associated amnestic syndrome. A mixed pattern hypoxic-ischemic encephalopathy can present with similar imaging findings as HLE, however subcortical sparing and lack of thalamic findings, as seen in this patient is not typical [6] . Like HLE, CHANTER syndrome affects the hippocampi, cerebellum, and basal ganglia, however diffuse cortical involvement is not seen.…”

“…Interestingly, diffuse involvement of basal ganglia was noted, and has only been documented in a few cases of opioid overdose [ 6 ]. We suspect that some component of hypoxic encephalopathy or CHANTER syndrome is involved, as the hippocampus, deep gray matter nuclei, and cerebellum are preferentially affected in the early stages.…”