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October 2021; 11 (5) The Nerve! Readers Speak

Reader Response: Amnestic Syndrome and Bilateral Hippocampal Diffusion Abnormalities From Opioid Use

View ORCID ProfileJason Randhawa, View ORCID ProfileTychicus Chen
First published October 11, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001131
Jason Randhawa
(Vancouver, BC),
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Tychicus Chen
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Reader Response: Amnestic Syndrome and Bilateral Hippocampal Diffusion Abnormalities From Opioid Use
Jason Randhawa, Tychicus Chen
Neurol Clin Pract Oct 2021, 11 (5) 600; DOI: 10.1212/CPJ.0000000000001131

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Reports of opioid-associated amnestic syndrome1 have increased with the rising use of opioids, particularly among young men.2 At our institution in British Columbia, which has one of the highest rates of opioid-related hospitalizations in Canada,3 we have observed at least 3 such cases in the last 4 years with similar initial imaging. All were positive for fentanyl on urine toxicology. One of these was associated with a delayed leukoencephalopathy causing akinetic mutism, which developed roughly 3 weeks after initial presentation with isolated anterograde amnesia. Diffuse delayed leukoencephalopathy was recently reported as an unexpected outcome of acute opioid-associated amnestic syndrome.4 It would be interesting to know the eventual outcome in this case, and if any follow-up was provided. Monitoring for a delayed leukoencephalopathy should be considered by neurologists caring for these vulnerable patients. Prognosis should be deferred until these patients have been stable for at least 1 month after presentation.

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  • Author disclosures are available upon request (ncpjournal{at}neurology.org)

  • © 2021 American Academy of Neurology

References

  1. 1.↵
    1. Ahlbach C,
    2. Holmes BB,
    3. Narvid J,
    4. Rosendale N
    . Amnestic syndrome and bilateral hippocampal diffusion abnormalities from opioid use. Neurol Clin Pract. 2021;11(5):e823-e824.
    OpenUrl
  2. 2.↵
    1. Barash JA,
    2. Whitledge J,
    3. Watson CJ, et al.
    Opioid-associated amnestic syndrome: description of the syndrome and validation of a proposed definition. J Neurol Sci. 2020;417:117048.
    OpenUrl
  3. 3.↵
    1. Belzak L,
    2. Halverson J
    . The opioid crisis in Canada: a national perspective. LA crise des opioïdes au Canada: une perspective nationale. Health Promot Chronic Dis Prev Can. 2018;38(6):224-233.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Switzer AR,
    2. Beland B,
    3. Sarna JR,
    4. Walzak A,
    5. Pfeffer G
    . Fentanyl overdose causing hippocampal ischaemia followed by delayed leukoencephalopathy. Can J Neurol Sci. 2020;47(3):398-399.
    OpenUrl

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