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Schwetye KE, Nair LR, Boyle J, Barash JA. Histopathologic correlates of opioid-associated injury in CHANTER syndrome: first report of a post-mortem examination. Acta Neuropathol 2024; 148:33. [PMID: 39215828 DOI: 10.1007/s00401-024-02797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/24/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
Opioid-associated brain injury may involve selective regions, including the hippocampi alone, globi pallidi, and cerebellar hemispheres. Opioid-associated amnestic syndrome, for example, is one clinical correlate of hippocampal injury as manifest by MRI abnormality. When all three regions are involved in what may be a more fulminant injury, the syndrome is termed "cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER)", initially described in 2019. Until now, to our knowledge, there have been no histopathologic correlates to the imaging findings specifically in CHANTER syndrome. Here, for the first time, we present histopathologic findings of the post-mortem brain from a patient who died from complications of CHANTER syndrome following fentanyl intoxication. These observations included microhemorrhage, reactive and necrotic vasculature, eosinophilic neuronal necrosis, axonal swelling and spheroids, and frank infarction. The findings support previous experimental models implicating both hypoxic-ischemic and cytotoxic mechanisms in the tissue damage associated with CHANTER syndrome, though further work is needed to better characterize the exact cellular pathways involved to develop targeted treatments.
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Affiliation(s)
- Katherine E Schwetye
- Department of Pathology and Immunology, Washington University School of Medicine, C.B. 8118, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Lakshmi Ramachandran Nair
- Department of Pathology and Lab Medicine, Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC, 20010, USA
| | - Joseph Boyle
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jed A Barash
- Veterans' Home, 91 Crest Avenue, Chelsea, MA, 02150, USA
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2
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Griffin K, Stitt D. Opioid-Associated Nervous System Injuries. Semin Neurol 2024; 44:452-458. [PMID: 38848747 DOI: 10.1055/s-0044-1787545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
With the rise of the opioid epidemic, the practicing neurologist must recognize the patterns of a growing number of opioid-associated neurological injuries. This is in addition to the classic toxidrome of miosis, altered mental status, and respiratory depression, which must never be overlooked, as it is reversible and potentially lifesaving. Several other idiosyncratic syndromes due to opioid-related nervous system insults are defined by their characteristic imaging findings and portend variable functional recovery. Opioid toxicity can not only lead to brain injury, but also spinal cord and, rarely, peripheral nerve injury. As several newer synthetic opioids are undetectable by most assays, a low threshold to suspect opioid exposure must be maintained.
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Affiliation(s)
- Kim Griffin
- Department of Neurology, Mayo Clinic, Rochester, New York
| | - Derek Stitt
- Department of Neurology, Mayo Clinic, Rochester, New York
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3
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Barash JA, Parikh M, Ergas R, DeMaria A. Is there a relationship between opioid use and transient global amnesia? Eur J Neurol 2024; 31:e16134. [PMID: 37955550 PMCID: PMC11235587 DOI: 10.1111/ene.16134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND PURPOSE Opioid-associated amnestic syndrome (OAS) and transient global amnesia (TGA) are conditions with clinical overlap. We therefore sought to determine whether opioid use might be associated with TGA. METHODS Data from the Massachusetts Department of Public Health Syndromic Surveillance program were queried to ascertain the frequency of opioid use among emergency department (ED) encounters for TGA compared to that for all other ED visits between January 2019 and June 2023. RESULTS A total of 13,188,630 ED visits were identified during the study period. Of 1417 visits for TGA, one visit met the exposure definition for opioid use. There were 13,187,213 visits for other indications, 57,638 of which were considered opioid-exposed. The odds ratio for the relationship between opioid use and TGA was 0.16 (95% confidence interval 0.02, 1.14). CONCLUSION Despite the clinical overlap between OAS and TGA, surveillance data from ED visits in Massachusetts do not suggest that opioid use is a risk factor for TGA, indicating that OAS and TGA are distinct entities.
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Affiliation(s)
| | - Megha Parikh
- Massachusetts Department of Public HealthBostonMassachusettsUSA
| | - Rosa Ergas
- Massachusetts Department of Public HealthBostonMassachusettsUSA
| | - Alfred DeMaria
- Massachusetts Department of Public HealthBostonMassachusettsUSA
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4
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Lang M, Colby S, Ashby-Padial C, Bapna M, Jaimes C, Rincon SP, Buch K. An imaging review of the hippocampus and its common pathologies. J Neuroimaging 2024; 34:5-25. [PMID: 37872430 DOI: 10.1111/jon.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
The hippocampus is a complex structure located in the mesial temporal lobe that plays a critical role in cognitive and memory-related processes. The hippocampal formation consists of the dentate gyrus, hippocampus proper, and subiculum, and its importance in the neural circuitry makes it a key anatomic structure to evaluate in neuroimaging studies. Advancements in imaging techniques now allow detailed assessment of hippocampus internal architecture and signal features that has improved identification and characterization of hippocampal abnormalities. This review aims to summarize the neuroimaging features of the hippocampus and its common pathologies. It provides an overview of the hippocampal anatomy on magnetic resonance imaging and discusses how various imaging techniques can be used to assess the hippocampus. The review explores neuroimaging findings related to hippocampal variants (incomplete hippocampal inversion, sulcal remnant and choroidal fissure cysts), and pathologies of neoplastic (astrocytoma and glioma, ganglioglioma, dysembryoplastic neuroepithelial tumor, multinodular and vacuolating neuronal tumor, and metastasis), epileptic (mesial temporal sclerosis and focal cortical dysplasia), neurodegenerative (Alzheimer's disease, progressive primary aphasia, and frontotemporal dementia), infectious (Herpes simplex virus and limbic encephalitis), vascular (ischemic stroke, arteriovenous malformation, and cerebral cavernous malformations), and toxic-metabolic (transient global amnesia and opioid-associated amnestic syndrome) etiologies.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha Colby
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Monika Bapna
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra P Rincon
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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5
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Barash JA, Kofke WA, DeMaria A. Amnesia as an Adverse Event Associated With Fentanyl: An Analysis of the US Food and Drug Administration Adverse Event Reporting System, 2011-2021. J Neurosurg Anesthesiol 2024; 36:88-89. [PMID: 36624568 DOI: 10.1097/ana.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - W Andrew Kofke
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Alfred DeMaria
- Massachusetts Department of Public Health, Jamaica Plain, MA
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6
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Atac MF, Vilanilam GK, Damalcheruvu PR, Pandey I, Vattoth S. Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in the setting of opioid and phencyclidine use. Radiol Case Rep 2023; 18:3496-3500. [PMID: 37554665 PMCID: PMC10405156 DOI: 10.1016/j.radcr.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023] Open
Abstract
Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a constellation of specific imaging findings characterized by cytotoxic edema in the bilateral hippocampi, cerebellar cortices, and basal ganglia in patients presenting with altered mental status in the setting of substance intoxication. Previous case reports have demonstrated a strong correlation between CHANTER syndrome and polysubstance abuse, particularly with opioid intoxication. The patient we present in this case was found unresponsive following opioid use and demonstrated a constellation of findings on initial and follow-up imaging, consistent with CHANTER syndrome. While cases of irreversible brain damage or death during hospitalization have been reported in the literature, our patient demonstrated near-full recovery a few days after admission to the hospital. We aim to highlight the presentation and progression of CHANTER syndrome and alert clinicians and radiologists to include this entity in their diagnostic checklist for patients with polysubstance abuse and altered mental status.
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Affiliation(s)
- Muhammed F. Atac
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St., Slot 556, Little Rock, AR, 72205 USA
| | - George K. Vilanilam
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St., Slot 556, Little Rock, AR, 72205 USA
| | - Prashanth Reddy Damalcheruvu
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St., Slot 556, Little Rock, AR, 72205 USA
| | - Ishan Pandey
- Pre Medicine Professional Track, Baylor University, Waco, TX, 76706, USA
| | - Surjith Vattoth
- Division of Neuroradiology, Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St., Slot 556, Little Rock, AR, 72205 USA
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Todaro DR, Li X, Pereira-Rufino LS, Manza P, Nasrallah IM, Das S, Childress AR, Kranzler HR, Volkow ND, Langleben DD, Shi Z, Wiers CE. Hippocampal volume loss in individuals with a history of non-fatal opioid overdose. Addict Biol 2023; 28:e13336. [PMID: 37753562 PMCID: PMC10626561 DOI: 10.1111/adb.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023]
Abstract
Incidence of opioid-related overdoses in the United States has increased dramatically over the past two decades. Despite public emphasis on overdose fatalities, most overdose cases are not fatal. Although there are case reports of amnestic syndromes and acute injury to the hippocampus following non-fatal opioid overdose, the effects of such overdoses on brain structure are poorly understood. Here, we investigated the neuroanatomical correlates of non-fatal opioid overdoses by comparing hippocampal volume in opioid use disorder (OUD) patients who had experienced an opioid overdose (OD; N = 17) with those who had not (NOD; N = 32). Voxel-based morphometry showed lower hippocampal volume in the OD group than in the NOD group, which on post hoc analysis was evident in the left but not the right hippocampus. These findings strengthen the evidence that hippocampal injury is associated with non-fatal opioid overdose, which is hypothesized to underlie overdose-related amnestic syndrome.
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Affiliation(s)
- Dustin R Todaro
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xinyi Li
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laís S Pereira-Rufino
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Morphology and Genetics, Federal University of São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
| | - Peter Manza
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Ilya M Nasrallah
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandhitsu Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Rose Childress
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Henry R Kranzler
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Nora D Volkow
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel D Langleben
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zhenhao Shi
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corinde E Wiers
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Barash JA, Schmahmann JD, Xie Z, Lev MH, El Fakhri G. Longitudinal Imaging in a Patient With Opioid-associated Amnestic Syndrome. Cogn Behav Neurol 2023; 36:194-197. [PMID: 37389894 PMCID: PMC10527331 DOI: 10.1097/wnn.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/09/2023] [Indexed: 07/01/2023]
Abstract
Since 2012, individuals with a history of opioid misuse have infrequently been observed to develop a sudden-onset amnestic syndrome associated with bilateral hippocampal-restricted diffusion on MRI. Follow-up imaging of this opioid-associated amnestic syndrome (OAS) has revealed persistent hippocampal abnormalities. Given these observations, as well as neuropathological studies demonstrating excessive tau deposition in the hippocampi and other brain regions of individuals with opioid misuse, we describe longitudinal imaging of a patient with a history of OAS from presentation through 53 months later, when tau positron emission tomography (PET) was performed. Our patient was a 21-year-old woman with a history of attention-deficit hyperactivity disorder and substance use disorder, including opioids (intravenous heroin), who was hospitalized for acute-onset, dense anterograde amnesia. Her urine toxicology screen was positive for opiates. On presentation, her brain MRI showed restricted diffusion as well as T2 and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the hippocampi and globi pallidi. On day 3, magnetic resonance spectroscopy of a right hippocampal region of interest showed a mild reduction of N-acetyl aspartate/creatine, slight elevation of choline/creatine, and the appearance of lactate/lipid and glutamate/glutamine peaks. At 4.5 months, there was resolution of restricted diffusion on MRI, although a minimal anterior T2 and FLAIR hyperintense signal in the right hippocampus persisted. However, by 53 months, when mild memory loss was reported, the hippocampi appeared normal on MRI, and [ 18 F]T807 (tau) PET showed no uptake suggestive of tau deposition. This case report supports the investigation into the hypothesis that OAS may follow a trajectory of reversible metabolic injury.
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Affiliation(s)
| | - Jeremy D. Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H. Lev
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Georges El Fakhri
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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9
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McConnell E, Bai J. Hippocampal and Cerebellar Involvement in Opioid-Associated Amnestic Syndrome: A Unique Case Report. Cureus 2023; 15:e44248. [PMID: 37772208 PMCID: PMC10524798 DOI: 10.7759/cureus.44248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
We present a case of opioid-associated amnestic syndrome (OAS) in a 46-year-old female with persistent acute anterograde amnesia and biochemically confirmed with fentanyl use. The brain Magnetic Resonance Imaging (MRI) examination demonstrated symmetric restricted diffusion and T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities in the hippocampi and cerebellum. While cases of cerebellar findings in OAS are rare in the literature, this is a unique case with corresponding images that demonstrate cerebellar involvement in addition to the more common hippocampal finding.
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Affiliation(s)
- Evan McConnell
- Imaging Science, University of Rochester Medical Center, Rochester, USA
| | - James Bai
- Imaging Science, University of Rochester Medical Center, Rochester, USA
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10
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Xavier CG, Kuo M, Desai R, Palis H, Regan G, Zhao B, Moe J, Scheuermeyer FX, Gan WQ, Sabeti S, Meilleur L, Buxton JA, Slaunwhite AK. Association between toxic drug events and encephalopathy in British Columbia, Canada: a cross-sectional analysis. Subst Abuse Treat Prev Policy 2023; 18:42. [PMID: 37420239 PMCID: PMC10329314 DOI: 10.1186/s13011-023-00544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/03/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Encephalopathy can occur from a non-fatal toxic drug event (overdose) which results in a partial or complete loss of oxygen to the brain, or due to long-term substance use issues. It can be categorized as a non-traumatic acquired brain injury or toxic encephalopathy. In the context of the drug toxicity crisis in British Columbia (BC), Canada, measuring the co-occurrence of encephalopathy and drug toxicity is challenging due to lack of standardized screening. We aimed to estimate the prevalence of encephalopathy among people who experienced a toxic drug event and examine the association between toxic drug events and encephalopathy. METHODS Using a 20% random sample of BC residents from administrative health data, we conducted a cross-sectional analysis. Toxic drug events were identified using the BC Provincial Overdose Cohort definition and encephalopathy was identified using ICD codes from hospitalization, emergency department, and primary care records between January 1st 2015 and December 31st 2019. Unadjusted and adjusted log-binomial regression models were employed to estimate the risk of encephalopathy among people who had a toxic drug event compared to people who did not experience a toxic drug event. RESULTS Among people with encephalopathy, 14.6% (n = 54) had one or more drug toxicity events between 2015 and 2019. After adjusting for sex, age, and mental illness, people who experienced drug toxicity were 15.3 times (95% CI = 11.3, 20.7) more likely to have encephalopathy compared to people who did not experience a drug toxicity event. People who were 40 years and older, male, and had a mental illness were at increased risk of encephalopathy. CONCLUSIONS There is a need for collaboration between community members, health care providers, and key stakeholders to develop a standardized approach to define, screen, and detect neurocognitive injury related to drug toxicity.
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Affiliation(s)
- Chloé G Xavier
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Overdose Emergency Response Centre, Ministry of Mental Health and Addictions, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Roshni Desai
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Heather Palis
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Gemma Regan
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada
- Woodward Instructional Resource Centre, Vancouver, BC, V6T 1Z3, Canada
| | - Bin Zhao
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jessica Moe
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Department of Emergency Medicine, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Frank X Scheuermeyer
- St Paul's Hospital and the Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Centre for Health Evaluation & Outcomes Sciences, St Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Wen Qi Gan
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Soha Sabeti
- Health Surveillance, First Nations Health Authority, 100 Park Royal S, West Vancouver, BC, V7T 1A2, Canada
| | - Louise Meilleur
- Health Surveillance, First Nations Health Authority, 100 Park Royal S, West Vancouver, BC, V7T 1A2, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
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11
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Wu Y, Wang A, Fu L, Liu M, Li K, Chian S, Yao W, Wang B, Wang J. Fentanyl Induces Novel Conditioned Place Preference in Adult Zebrafish, Disrupts Neurotransmitter Homeostasis, and Triggers Behavioral Changes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13533. [PMID: 36294112 PMCID: PMC9603063 DOI: 10.3390/ijerph192013533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Abuse of new psychoactive substances increases risk of addiction, which can lead to serious brain disorders. Fentanyl is a synthetic opioid commonly used in clinical practice, and behavioral changes resulting from fentanyl addiction have rarely been studied with zebrafish models. In this study, we evaluated the rewarding effects of intraperitoneal injections of fentanyl at concentrations of 10, 100, and 1000 mg/L on the group shoaling behavior in adult zebrafish. Additional behavioral tests on individual zebrafish, including novel tank, novel object exploration, mirror attack, social preference, and T-maze memory, were utilized to evaluate fentanyl-induced neuro-behavioral toxicity. The high doses of 1000 mg/L fentanyl produced significant reward effects in zebrafish and altered the neuro-behavioral profiles: reduced cohesion in shoaling behavior, decreased anxiety levels, reduced exploratory behavior, increased aggression behavior, affected social preference, and suppressed memory in an appetitive associative learning task. Behavioral changes in zebrafish were shown to be associated with altered neurotransmitters, such as elevated glutamine (Gln), gamma-aminobutyric acid (GABA), dopamine hydrochloride (DA), and 5-hydroxytryptamine (5-HT). This study identified potential fentanyl-induced neurotoxicity through multiple neurobehavioral assessments, which provided a method for assessing risk of addiction to new psychoactive substances.
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Affiliation(s)
- Yuanzhao Wu
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Anli Wang
- National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Fuli Institute of Food Science, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Lixiang Fu
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
- Office of Criminal Science and Technology, Xiaoshan District Branch of Hangzhou Public Security Bureau, Hangzhou 310002, China
| | - Meng Liu
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Kang Li
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Song Chian
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Weixuan Yao
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Binjie Wang
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
| | - Jiye Wang
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, The Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou 310053, China
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12
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Mallikarjun KS, Parsons MS, Nigogosyan Z, Goyal MS, Eldaya RW. Neuroimaging Findings in CHANTER Syndrome: A Case Series. AJNR Am J Neuroradiol 2022; 43:1136-1141. [PMID: 35798385 PMCID: PMC9575414 DOI: 10.3174/ajnr.a7569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022]
Abstract
Recently, a distinct clinicoradiologic entity involving cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) on MR imaging was identified. Patients present in an unresponsive state following exposure to drugs of abuse. Very little information exists regarding this entity, particularly in the radiology literature. We identify and describe 3 patients at our institution with similar clinical and radiographic findings. Multifocal restricted diffusion in the brain is typically associated with poor outcomes. By contrast, CHANTER involves intraventricular obstructive hydrocephalus that, when treated, can lead to substantial recovery. This novel syndrome should be on the differential in patients who present in an unresponsive state after recent opioid use in the context of the above imaging findings. Additional diagnoses on the differential can include ischemic stroke, hypoxic-ischemic encephalopathy, "chasing the dragon," leukoencephalopathy, opioid-associated amnestic syndrome, and pediatric opioid-use-associated neurotoxicity with cerebellar edema.
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Affiliation(s)
- K S Mallikarjun
- From the Mallinckrodt Institute of Radiology (K.S.M., M.S.P., Z.N., M.S.G., R.W.E.), Washington University School of Medicine, Ringgold Standard Institution, St. Louis, Missouri
| | - M S Parsons
- From the Mallinckrodt Institute of Radiology (K.S.M., M.S.P., Z.N., M.S.G., R.W.E.), Washington University School of Medicine, Ringgold Standard Institution, St. Louis, Missouri
| | - Z Nigogosyan
- From the Mallinckrodt Institute of Radiology (K.S.M., M.S.P., Z.N., M.S.G., R.W.E.), Washington University School of Medicine, Ringgold Standard Institution, St. Louis, Missouri
| | - M S Goyal
- From the Mallinckrodt Institute of Radiology (K.S.M., M.S.P., Z.N., M.S.G., R.W.E.), Washington University School of Medicine, Ringgold Standard Institution, St. Louis, Missouri
| | - R W Eldaya
- From the Mallinckrodt Institute of Radiology (K.S.M., M.S.P., Z.N., M.S.G., R.W.E.), Washington University School of Medicine, Ringgold Standard Institution, St. Louis, Missouri.,MD Anderson Cancer Center, Diagnostic Imaging Division (R.W.E.), Houston, Texas
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13
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Application of an Existing Syndromic Surveillance System to Quantify Possible Cases of Opioid-associated Amnestic Syndrome in Massachusetts. J Addict Med 2022; 16:684-688. [PMID: 35678426 DOI: 10.1097/adm.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In recent years, an opioid-associated amnestic syndrome (OAS) was identified in Massachusetts through elicited reporting by health care providers (traditional surveillance, TS). Whether OAS occurs more frequently and with a wider spatiotemporal distribution in Massachusetts remains unclear. We compared the frequency and spatiotemporal characteristics of emergency department (ED) visits for possible OAS (pOAS) using a pre-existing syndromic surveillance system (SyS) with OAS cases captured through TS. METHODS SyS was queried for Massachusetts ED visits in 15- to 55-year-olds with a chief complaint text and discharge codes for memory loss in association with codes for opioid use (pOAS). SyS data were extracted for 2016-2020, whereas TS was conducted for 2012-2018. Cases identified by SyS and TS were stratified by demographic and spatiotemporal variables. RESULTS TS ascertained 22 reported cases of OAS (18 males) between 2012 and 2018, ranging from 0 to 5 annually. No identified OAS patients presented between January and March or in western Massachusetts. Between 2016 and 2020, SyS identified 82 ED visits (49 males) with pOAS, ranging from 13 to 22 per year. Over the 5-year period, at least 2 ED visits for pOAS occurred during each month of the year (24 total during January, February, or March) and at least 1 visit occurred in each county except 2, with the second largest number (11) in Berkshire County (at the western border of Massachusetts), where no cases were ascertained through TS. CONCLUSIONS Although OAS is a relatively rare condition, use of SyS in Massachusetts suggests a broader and more frequent spatiotemporal distribution than previously indicated from TS.
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14
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Walker ML, Patel K, Li T, Kassir M. Opioid-Associated Amnestic Syndrome. Cureus 2021; 13:e20056. [PMID: 34877229 PMCID: PMC8642152 DOI: 10.7759/cureus.20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
Opioid-associated amnestic syndrome (OAS) is a relatively new condition that is associated with opioid abuse and has increased in prevalence since the notable rise in opioid-related deaths and opioid-related hospitalizations of the opioid crisis. Patients often present with acute anterograde amnesia and current opioid abuse, most commonly fentanyl. OAS is frequently diagnosed when other potentially infectious or metabolic conditions such as encephalitis and seizures are ruled out, as these conditions can also present similarly to OAS. This case highlights the signs, symptoms, and hallmark characteristics of OAS, including bilateral hippocampal edema and anterograde amnesia.
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Affiliation(s)
- Macey L Walker
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Keshav Patel
- Internal Medicine, University of Illinois College of Medicine, Chicago, USA
| | - Tong Li
- Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Mahmoud Kassir
- Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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15
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Barash J, Kofke WA, Badiola I. Letter to the editor: in response to 'association between widespread pain and dementia, Alzheimer's disease and stroke: a cohort study from the Framingham Heart Study'. Reg Anesth Pain Med 2021; 47:270. [PMID: 34725258 DOI: 10.1136/rapm-2021-103190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Jed Barash
- Department of Medicine, Soldiers' Home, Chelsea, Massachusetts, USA
| | - W Andrew Kofke
- Department of Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ignacio Badiola
- Department of Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Assessing Memory Loss in a Young Adult with Substance Use Disorder: Remember the Timing of Presentation. Harv Rev Psychiatry 2021; 29:246-250. [PMID: 32925309 DOI: 10.1097/hrp.0000000000000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Caplan RA, Zuflacht JP, Barash JA, Fehnel CR. Neurotoxicology Syndromes Associated with Drugs of Abuse. Neurol Clin 2021; 38:983-996. [PMID: 33040873 DOI: 10.1016/j.ncl.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Substance use disorders-and their associated neurologic complications-are frequently encountered by neurologists as well as emergency room physicians, internists, psychiatrists, and medical intensivists. Prominent neurologic sequelae of drug abuse, such as seizure and stroke, are common and often result in patients receiving medical attention. However, less overt neurologic manifestations, such as dysautonomia and perceptual disturbances, may be initially misattributed to primary medical or psychiatric illness, respectively. This article focuses on the epidemiology, pharmacology, and complications associated with commonly used recreational drugs, including opioids, alcohol, marijuana, cocaine, and hallucinogens.
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Affiliation(s)
- Rachel A Caplan
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street WACC 721G, Boston, Massachusetts 02114, USA; Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA
| | - Jonah P Zuflacht
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 406D, Boston, MA 02215, USA
| | - Jed A Barash
- Soldiers' Home, 91 Crest Avenue, Chelsea, MA 02150, USA
| | - Corey R Fehnel
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Kirstein 471, Boston, MA 02215, USA; Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA 02131, USA.
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18
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Barash JA, Whitledge J, Watson CJ, Boyle K, Lim C, Lev MH, DeMaria A, Ganetsky M. Opioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definition. J Neurol Sci 2020; 417:117048. [PMID: 32739497 DOI: 10.1016/j.jns.2020.117048] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE An opioid-associated amnestic syndrome (OAS) characterized by acute onset memory loss and bilateral hippocampal signal abnormalities on brain imaging in the setting of a history of opioid use, most notably fentanyl, has been reported. To date, however, there is no case definition to assist neurologists and other clinicians in identifying this syndrome. A multi-disciplinary collaboration of physicians, including neurologists, propose diagnostic criteria for OAS using cases that have been published in the medical literature or presented at conferences. METHODS Cases were classified as confirmed, probable, or possible based on brain imaging findings and history or analytical testing supporting opioid use. Published articles and presentations were identified by discussion with public health authorities and a systematic search of PubMed. Included were articles, abstracts or posters through November 2019 that presented case reports or case series of a new-onset amnestic syndrome associated with bilateral hippocampal injury on imaging and/or prior opioid or other substance use. The percentages of cases that would meet confirmed, probable, or possible criteria were calculated. RESULTS Twenty-three publications from all sources met criteria for inclusion, accounting for 40 unique cases. Based on the case definition of OAS, 50% (20/40) were confirmed, 25% (10/40) were probable and 25% (10/40) were possible. CONCLUSION The development of a validated, formal case definition for OAS can assist neurologists and other clinicians in evaluating patients with amnesia and a history of opioid use.
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Affiliation(s)
- Jed A Barash
- Department of Medicine, Soldiers' Home, Chelsea, MA, USA.
| | - James Whitledge
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C James Watson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katherine Boyle
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Chun Lim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alfred DeMaria
- Massachusetts Department of Public Health, Jamaica, Plain, MA, USA
| | - Michael Ganetsky
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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19
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Abstract
Background Abnormal restricted diffusion on magnetic resonance imaging is often associated with ischemic stroke or anoxic injury, but other conditions can present similarly. We present six cases of an unusual but consistent pattern of restricted diffusion in bilateral hippocampi and cerebellar cortices. This pattern of injury is distinct from typical imaging findings in ischemic, anoxic, or toxic injury, suggesting it may represent an under-recognized clinicoradiographic syndrome. Despite initial presentation with stupor or coma in the context of obstructive hydrocephalus, patients may have acceptable outcomes if offered early intervention. Methods We identified an ad hoc series of patients at our two institutions between years 2014 and 2017 who presented to the neurocritical care unit with severe, otherwise unexplained cerebellar edema and retrospectively identified several commonalities in history, presentation, and imaging. Results Between two institutions, we identified six patients—ages 33–59 years, four male—with similar presentations of decreased level of consciousness in the context of intoxicant exposure, with acute cytotoxic edema of the cerebellar cortex, hippocampi, and aspects of the basal nuclei. All patients presented with severe cerebellar edema which led to obstructive hydrocephalus requiring aggressive medical and/or surgical management. The five patients who survived to discharge demonstrated variable degrees of physical and memory impairment on discharge and at follow-up. Conclusions We present findings of a potentially novel syndrome involving a distinct pattern of cerebellar and hippocampal restricted diffusion, with imaging and clinical characteristics distinct from ischemic stroke, hypoxic injury, and known toxidromes and leukoencephalopathies. Given the potential for favorable outcome despite early obstructive hydrocephalus, early identification and treatment of this syndrome are critical.
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20
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Fentanyl Overdose Causing Hippocampal Ischaemia Followed by Delayed Leukoencephalopathy. Can J Neurol Sci 2020; 47:398-399. [DOI: 10.1017/cjn.2020.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Taylor RG, Budhram A, Lee DH, Mirsattari SM. Opioid-associated amnestic syndrome observed with fentanyl patch use. CMAJ 2019; 191:E337-E339. [PMID: 30910881 DOI: 10.1503/cmaj.181291] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ryan G Taylor
- Department of Clinical Neurological Sciences (Taylor, Budhram, Lee, Mirsattari), and Division of Radiology (Lee), Western University, London, Ont.
| | - Adrian Budhram
- Department of Clinical Neurological Sciences (Taylor, Budhram, Lee, Mirsattari), and Division of Radiology (Lee), Western University, London, Ont
| | - Donald H Lee
- Department of Clinical Neurological Sciences (Taylor, Budhram, Lee, Mirsattari), and Division of Radiology (Lee), Western University, London, Ont
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences (Taylor, Budhram, Lee, Mirsattari), and Division of Radiology (Lee), Western University, London, Ont
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22
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The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Transl Psychiatry 2019; 9:282. [PMID: 31712552 PMCID: PMC6848196 DOI: 10.1038/s41398-019-0625-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/10/2019] [Accepted: 10/20/2019] [Indexed: 12/11/2022] Open
Abstract
Fentanyl is a powerful opioid anesthetic and analgesic, the use of which has caused an increasing public health threat in the United States and elsewhere. Fentanyl was initially approved and used for the treatment of moderate to severe pain, especially cancer pain. However, recent years have seen a growing concern that fentanyl and its analogs are widely synthesized in laboratories and adulterated with illicit supplies of heroin, cocaine, methamphetamine, and counterfeit pills, contributing to the exponential growth in the number of drug-related overdose deaths. This review summarizes the recent epidemic and evolution of illicit fentanyl use, its pharmacological mechanisms and side effects, and the potential clinical management and prevention of fentanyl-related overdoses. Because social, economic, and health problems that are related to the use of fentanyl and its analogs are growing, there is an urgent need to implement large-scale safe and effective harm reduction strategies to prevent fentanyl-related overdoses.
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23
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Taylor RG, Mirsattari SM, Lee DH. The authors respond to "Fentanyl patch probably not related to amnesia in case". CMAJ 2019; 191:E1226-E1227. [PMID: 31685669 PMCID: PMC6834446 DOI: 10.1503/cmaj.73774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ryan G Taylor
- Neurology resident, Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Seyed M Mirsattari
- Associate professor of neurology, Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Donald H Lee
- Professor, Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ont
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24
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Hong JS, Moran MT, Eaton LA, Grafton LM. Neurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00247-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Ferguson MA, Lim C, Cooke D, Darby RR, Wu O, Rost NS, Corbetta M, Grafman J, Fox MD. A human memory circuit derived from brain lesions causing amnesia. Nat Commun 2019; 10:3497. [PMID: 31375668 PMCID: PMC6677746 DOI: 10.1038/s41467-019-11353-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022] Open
Abstract
Human memory is thought to depend on a circuit of connected brain regions, but this hypothesis has not been directly tested. We derive a human memory circuit using 53 case reports of strokes causing amnesia and a map of the human connectome (n = 1000). This circuit is reproducible across discovery (n = 27) and replication (n = 26) cohorts and specific to lesions causing amnesia. Its hub is at the junction of the presubiculum and retrosplenial cortex. Connectivity with this single location defines a human brain circuit that incorporates > 95% of lesions causing amnesia. Lesion intersection with this circuit predicts memory scores in two independent datasets (N1 = 97, N2 = 176). This network aligns with neuroimaging correlates of episodic memory, abnormalities in Alzheimer's disease, and brain stimulation sites reported to enhance memory in humans.
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Affiliation(s)
- Michael A Ferguson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Chun Lim
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Danielle Cooke
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Natalia S Rost
- Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Maurizio Corbetta
- Dipartimento di Neuroscienze, Università di Padova, Padova, 35122, Italy
- Departments of Neurology, Radiology, Neuroscience, and Bioengineering, Washington University, School of Medicine, St. Louis, 63110, USA
- Padova Neuroscience Center, Università di Padova, Padova, 35131, Italy
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think + Speak Lab, Shirley Ryan Ability Lab, 355 E Erie St., Chicago, 60611, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
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26
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Mancano MA, Lapin J, Paik A. ISMP Adverse Drug Reactions: Pheochromocytoma Crisis Induced by Metoclopramide Baclofen Dependence Following High-Dose Therapy Fatal Cardiotoxicity Following High-Dose Cyclophosphamide Acute Anterograde Amnestic Syndrome Induced by Fentanyl Ivermectin-Induced Toxic Epidermal Necrolysis Pembrolizumab-Induced Type 1 Diabetes. Hosp Pharm 2019; 54:241-245. [PMID: 31320773 DOI: 10.1177/0018578719828860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. E-mail Dr. Mancano at michael.mancano@temple.edu. Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MedWatch program and Temple University School of Pharmacy. ISMP is an FDA MedWatch partner.
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Affiliation(s)
| | - Jonathan Lapin
- Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Andrew Paik
- Temple University School of Pharmacy, Philadelphia, PA, USA
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27
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Butler PM, Barash JA, Casaletto KB, Cotter DL, Joie RL, Geschwind MD, Rosen HJ, Kramer JH, Miller BL. An Opioid-Related Amnestic Syndrome With Persistent Effects on Hippocampal Structure and Function. J Neuropsychiatry Clin Neurosci 2019; 31:392-396. [PMID: 31177905 PMCID: PMC7469957 DOI: 10.1176/appi.neuropsych.19010017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P. Monroe Butler
- The Department of Neurology, University of California at San Francisco
| | - Jed A. Barash
- The Department of Neurology, University of California at San Francisco and Soldiers’ Home, Chelsea, Mass
| | | | - Devyn L. Cotter
- The Department of Neurology, University of California at San Francisco
| | - Renaud La Joie
- The Department of Neurology, University of California at San Francisco
| | | | - Howie J. Rosen
- The Department of Neurology, University of California at San Francisco
| | - Joel H. Kramer
- The Department of Neurology, University of California at San Francisco
| | - Bruce L. Miller
- The Department of Neurology, University of California at San Francisco
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28
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Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662-663. [PMID: 30398631 PMCID: PMC6464382 DOI: 10.7326/l18-0411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Uzoma B Duru
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Gauri Pawar
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | | | - Liv E Miller
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Indrani K Thiruselvam
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
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29
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D'Errico S. Commentary. Fentanyl-related death and the underreporting risk. J Forensic Leg Med 2018; 60:35-37. [PMID: 30265903 DOI: 10.1016/j.jflm.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
Novel synthetic opioid overdose deaths have been rising largely worldwide as a result of fentanyl adulteration in the illegal drug supply. Interpretation of post mortem analytical results concerning fentanyl can be challenging in particular due to redistribution phenomena. Lacking of resources, infrastructures and expertise to perform forensic toxicological investigation when an unknown drug or complex mixture of drugs is suspected can affect failure in exactly reporting cause in drug related death. Public safety and public health entities are called working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids.
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Affiliation(s)
- Stefano D'Errico
- Department of Legal Medicine, Azienda USL Toscana Nordovest, Lucca, Italy.
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30
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Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB. Abuse of fentanyl: An emerging problem to face. Forensic Sci Int 2018; 289:207-214. [DOI: 10.1016/j.forsciint.2018.05.042] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 01/02/2023]
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31
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Affiliation(s)
| | | | - Alfred DeMaria
- Massachusetts Department of Public Health, Jamaica Plain, MA
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32
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Abstract
Acute hippocampal injury represents a relatively rare cause of amnesia. Interestingly however, between 2012 and 2017, 18 patients were reported at hospitals in Massachusetts with sudden-onset amnesia in the setting of complete diffusion-weighted hyperintensity of both hippocampi on magnetic resonance imaging. Notably, 17 of the 18 patients tested positive for opioids or had a recorded history of opioid use. This observation suggests an association between opioids and acute hippocampal injury. With particular attention to the Massachusetts cluster and data on fentanyl and its congeners, the epidemiological and pathophysiological evidence that supports this hypothesis is presented, as are potential underlying mechanisms.
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Affiliation(s)
- Jed A Barash
- a Department of Medicine , Quigley Memorial Hospital, Soldiers' Home , Chelsea , MA , USA
| | - W Andrew Kofke
- b Department of Anesthesiology and Critical Care , University of Pennsylvania School of Medicine , Philadelphia , PA , USA
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