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Opioid-Induced Leukoencephalopathies: A Report of Two Cases
Gustav Højrup Knudsen1, Nata Kermanian1, Carsten Hanshelge Kock-Jensen2
1Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg, Denmark.
Case Reports in Neurology
|February 28, 2022
Summary
Acute toxic leukoencephalopathy (ATL) and delayed post-hypoxic leukoencephalopathy (DPHL) are distinct opioid intoxication complications. DPHL shows biphasic deterioration with cystic changes, aiding differentiation from ATL.
Area of Science:
- Neurology
- Radiology
- Toxicology
Background:
- Opioid intoxication (OI) can lead to distinct neurological adverse events: acute toxic leukoencephalopathy (ATL) and delayed post-hypoxic leukoencephalopathy (DPHL).
- ATL presents a monophasic clinical course, while DPHL exhibits a biphasic pattern.
Observation:
- This report details two young male patients with OI, one experiencing ATL and the other DPHL.
- Both cases demonstrated initial magnetic resonance imaging (MRI) findings of confluent, symmetric white matter (WM) abnormalities.
- The DPHL patient later developed WM cystic degeneration, a characteristic feature.
Findings:
- Initial MRI in both ATL and DPHL shows periventricular WM abnormalities on T2/FLAIR and restricted diffusion on DWI.
- Distinctive WM cystic substance loss was observed in the deterioration phase of DPHL.
- Similar WM changes have been noted in COVID-19-associated leukoencephalopathy, suggesting shared pathophysiology.
Implications:
- Recognizing distinct clinical and imaging features of ATL and DPHL is crucial for accurate diagnosis in opioid intoxication.
- Differentiating these entities aids in appropriate patient management and understanding of neurotoxic mechanisms.
- Potential common pathophysiological pathways between OI-related leukoencephalopathies and viral-associated leukoencephalopathies warrant further investigation.
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