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Area of Science:

  • Neurology
  • Toxicology
  • Radiology

Background:

  • Opioid toxicity can present with diverse neurological symptoms.
  • Globus pallidus (GP) is typically spared in hypoxic-ischemic encephalopathy.
  • Autopsy studies indicate specific GP involvement in intravenous heroin users.

Purpose of the Study:

  • To investigate the neurological effects of suspected heroin snorting.
  • To correlate clinical presentation with neuroimaging findings in opioid toxicity.
  • To highlight the characteristic pattern of globus pallidus injury in heroin users.

Main Methods:

  • Case presentation of a 54-year-old man with confusion and Parkinsonian features.
  • Brain magnetic resonance imaging (MRI) to assess for abnormalities.
  • Review of literature on opioid toxicity and neuropathology.

Main Results:

  • MRI revealed isolated, symmetric, bilateral globus pallidus restricted diffusion and edema.
  • Findings were consistent with hypoxic ischemic encephalopathy.
  • The pattern of injury differed from typical anoxic insults, with preferential GP involvement.

Conclusions:

  • Opioid toxicity should be considered in patients with Parkinsonian features and pallidal lesions on imaging.
  • Heroin use, particularly snorting, may specifically target the globus pallidus.
  • This presentation is particularly relevant in younger adults where infarction is less common.