1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2023, Issue 4
  5. Article
Volume 2023, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

The opioid crisis has become a significant public health concern in recent years. Although respiratory depression and overdose are the most reported side effects of fentanyl, there have been rare cases of cerebellar leukoencephalopathy (CLE) following fentanyl intoxication. A 29-year-old man with a history of opioid use disorder and intravenous drug use presented to the emergency room with significant ataxia and dysarthria following fentanyl intoxication. According to the patient, the symptoms began four days prior after “chasing the dragon” with “pure fentanyl”, and he reported experiencing nausea and dizziness, particularly during ambulation. Neurological examination revealed a positive Romberg test, ataxia, and delayed speech. Brain magnetic resonance imaging (MRI) indicated there was toxic degeneration of the cerebellar white matter that extended into the posterior limbs of the internal capsule. Urine drug screening was positive for opioids, making fentanyl-induced cerebellar leukoencephalopathy the most likely diagnosis in this case. This case of opioid-induced CLE underscores the critical significance of early recognition, which is vital for enhancing a patient’s recovery and averting the development of severe neurological complications.

© 2023 Ramawad, Toloui, Chen, Sun, Licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2023.36
2024-01-06
2024-11-09
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2023/4/qmj.2023.36.html?itemId=/content/journals/10.5339/qmj.2023.36&mimeType=html&fmt=ahah

References

  1. US Department of Health and Human Services, CDC [Internet] . National Center for Health Statistics Mortality Data on CDC WONDER, c2021 [cited 2023 January 31]. Available from: https://www.cdc.gov/nchs/products/databriefs/db456.htm#:~:text=Life%20expectancy%20for%20the%20U.S.,group%201%20year%20and%20over.
     [Google Scholar]
  2. Switzer AR, Beland B, Sarna JR, Walzak A, Pfeffer G. Fentanyl overdose causing Hippocampal Ischaemia followed by delayed Leukoencephalopathy. Can J Neurol Sci. 2020 May; 47:(3):398-399. doi: 10.1017/cjn.2020.33.
     [Google Scholar]
  3. Choi JS, Yoo EA, Choi JO, Kim SJ. 펜타닐 첩포 남용으로 인한 지연성 저산소성 백색질뇌증: 증례 보고 [Delayed Post-Hypoxic Leukoencephalopathy Induced by an Overdose with Fentanyl Patches: A Case Report]. Taehan Yongsang Uihakhoe Chi. 2020 Jul; 81:(4):972-978. Korean. doi: 10.3348/jksr.2020.81.4.972.
     [Google Scholar]
  4. Foy L, Seeyave DM, Bradin SA. Toxic leukoencephalopathy due to transdermal fentanyl overdose. Pediatr Emerg Care. 2011 Sep; 27:(9):854-6. doi: 10.1097/PEC.0b013e31822c281f.
    [Google Scholar]
  5. Adra N, Goodheart AE, Rapalino O, Caruso P, Mukerji SS, González RG, et al.. MRI Shrimp Sign in Cerebellar Progressive Multifocal Leukoencephalopathy: Description and Validation of a Novel Observation. AJNR Am J Neuroradiol. 2021 Jun; 42:(6):1073-1079. doi: 10.3174/ajnr.A7145.
     [Google Scholar]
  6. Strang J, Griffiths P, Gossop M. Heroin smoking by ‘chasing the dragon’: origins and history. Addiction. 1997 Jun; 92:(6):673-83. doi: 10.1046/j.1360-0443.1997.9266734.x.
     [Google Scholar]
  7. Kim J, Hyung SW, Seo J, Lee H, Yu HJ, Sunwoo MK. Delayed Post-Hypoxic Leukoencephalopathy Caused by Fentanyl Intoxication in a Healthy Woman. Dement Neurocogn Disord. 2020 Dec; 19:(4):170-172. doi: 10.12779/dnd.2020.19.4.170.
     [Google Scholar]
  8. Chen CH, Mullen AJ, Hofstede D, Rizvi T. Malignant cerebellar edema in three-year-old girl following accidental opioid ingestion and fentanyl administration. Neuroradiol J. 2019 Oct; 32:(5):386-391.doi: 10.1177/1971400919863713.
     [Google Scholar]
  9. Meng D, Randhawa J. Opioid-Associated Amnestic Syndrome Progressing to Diffuse Leukoencephalopathy. Neurohospitalist. 2023 Jan; 13:(1):109-110. doi: 10.1177/19418744211045862.
     [Google Scholar]
  10. Nanan R, von Stockhausen HB, Petersen B, Solymosi L, Warmuth-Metz M. Unusual pattern of leukoencephalopathy after morphine sulphate intoxication. Neuroradiology. 2000 Nov; 42:(11):845-8. doi: 10.1007/s002340000442.
    [Google Scholar]
  11. Wheaton T, Toll BJ, Breznak K, Da-Silva S, Melvin J, Misra A, Hwang SW. Opioid-induced toxic leukoencephalopathy: A case report and review of the literature. Heliyon. 2019 Dec 11; 5:(12):e03005. doi: 10.1016/j.heliyon.2019.e03005.
    [Google Scholar]
  12. Aminoff MJ, Daroff RB, Patterson MC. Leukoencephalopathy. In: Encyclopedia of the Neurological Sciences. 2nd ed. Oxford: Academic Press; 2014. p. 878–9.
    [Google Scholar]
  13. Theisen A, Bose P, Knight C, Oliver M. Leukoencephalopathy and cerebral edema as the presenting manifestations of SLE in an ANA-negative adolescent female: a case report and review of literature. Pediatr Rheumatol Online J. 2020 Jul 13; 18:(1):58. doi: 10.1186/s12969-020-00449-2.
     [Google Scholar]
  14. Schiller EY, Goyal A, Mechanic OJ. Opioid Overdose. 2023 Jul 21.
     [Google Scholar]
  15. Nehring SM, Tadi P, Tenny S. Cerebral Edema. 2023 Jul 3.
     [Google Scholar]
  16. Kozler P, Marešová D, Pokorný J. Effect of methylprednisolone on experimental brain edema in rats - own experience reviewed. Physiol Res. 2021 Dec 31; 70:(S3):S289-S300. doi: 10.33549/physiolres.934818.
     [Google Scholar]
/content/journals/10.5339/qmj.2023.36
Loading
Cerebellar Leukoencephalopathy following Fentanyl Intoxication. A case report and review of the literature
Qatar Medical Journal 2023, 36 (2024); https://doi.org/10.5339/qmj.2023.36
/content/journals/10.5339/qmj.2023.36
/content/journals/10.5339/qmj.2023.36
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): addiction medicine, altered mental status, ataxia, Fentanyl overdose, leukoencephalopathy and opioid

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error