Reader response: Amnestic Syndrome and Bilateral Hippocampal Diffusion Abnormalities From Opioid Use
JasonRandhawa, Neurology PGY-5, St. Paul's Hospital
TychicusChen, Neurologist, University of British Columbia
Submitted January 31, 2021
Reports of opioid-associated amnestic syndrome1 have increased with the rising use of opioids, particularly among young males.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 three such cases in the last four 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 three 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 one month following presentation.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Ahlbach C, Holmes B, Narvid J, Rosendale N. Amnestic Syndrome and Bilateral Hippocampal Diffusion Abnormalities From Opioid Use. Neurol Clin Pract Jan 2021, 10.1212/CPJ.0000000000001056; DOI: 10.1212/CPJ.0000000000001056
Barash JA, Whitledge J, Watson CJ, et al. Opioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definition. J Neurol Sci. 2020;417:117048. doi:10.1016/j.jns.2020.117048
Belzak L, 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. doi:10.24095/hpcdp.38.6.02
Switzer AR, Beland B, Sarna JR, Walzak A, Pfeffer G. Fentanyl Overdose Causing Hippocampal Ischaemia Followed by Delayed Leukoencephalopathy. Can J Neurol Sci. 2020;47(3):398-399. doi:10.1017/cjn.2020.33
Reports of opioid-associated amnestic syndrome1 have increased with the rising use of opioids, particularly among young males.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 three such cases in the last four 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 three 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 one month following presentation.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References