Fentanyl inhalation linked to irreversible brain damage

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Apr 29 2024BMJ

Inhaling nan synthetic opioid fentanyl whitethorn origin perchance irreversible encephalon harm (toxic leukoencephalopathy), pass doctors successful nan journal BMJ Case Reports, aft treating a mediate aged man recovered unresponsive successful his edifice room aft snorting nan drug.

Leukoencephalopathy refers to inflammation and harm to nan brain's achromatic matter-;the web of nervus fibres that alteration nan speech of accusation and connection betwixt different areas of nan brain's grey matter. 

Toxic leukoencephalopathy is simply a abrupt aliases longstanding neurological syndrome, which has been reported aft heroin inhalation, known arsenic 'chasing nan dragon'. But this is nan first reported lawsuit associated pinch fentanyl, opportunity nan study authors.

The information is manifest successful various signs and symptoms, nan astir evident of which are neurological and behavioral changes, ranging from mild disorder to stupor, coma, and death.

The outlook for those affected mostly depends connected nan grade of achromatic matter injury, explicate nan study authors: immoderate group will retrieve fully; others will progressively get worse.

In this case, nan man had nary erstwhile aesculapian problems of immoderate note, and had been unconscious for an chartless play of clip successful his edifice room, wherever unidentified crushed pills and a achromatic residue were recovered connected a adjacent table.

On presence astatine hospital, he wasn't capable to reply questions aliases travel commands. He responded to symptom stimuli to his legs, but not his arms.

A encephalon scan revealed achromatic matter inflammation and swelling and cerebellar injury. The cerebellum is nan portion of nan encephalon responsible for gait and balance. He tested antagonistic for epilepsy. 

A supplier surface returned antagonistic results, but a abstracted urine trial indicated a very precocious level of fentanyl, prompting a test of toxic leukoencephalopathy induced by fentanyl inhalation.

Eighteen days later, he remained bedbound and still required conduit feeding. He was fixed respective different narcotics to dainty urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, symptom and agitation, and pneumonia.

After 26 days he was discharged to a rehabilitation facility, and aft different period returned location pinch nan support of outpatient physiotherapy and occupational therapy.

Less than a twelvemonth aft his infirmary admittance he had afloat recovered and had returned to activity afloat time.

Commenting connected nan incident, he describes his betterment arsenic "miraculous", adding: "Early connected it was looking for illustration I would request 24 hr attraction aft being discharged, but I focused and worked difficult successful my therapy convention and was wished not to time off nan infirmary only to beryllium checked into a group installation for ongoing care."

Expressing gratitude to each nan healthcare professionals who not only saved his life, but enabled him to get backmost to nan life he had before, he says: "I person regrets often astir what I did to myself, my wife, and my family."

The study authors conclude: "This lawsuit illustrates nan request for inclusion of fentanyl successful regular urine supplier screens for earlier recognition and due management." 


Journal reference:

Eden, C. O., et al. (2024). Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy. BMJ Case Reports. doi.org/10.1136/bcr-2023-258395.