Diffuse cystic leucoencephalopathy after buprenorphine injection

Acute leukoencephalopathy after buprenorphine intoxication in a 2-year-old child

Leukoencephalopathies have been reported after heroin inhalation or ingestion, and buprenorphine injection, but the physiopathology remains unclear. We report here the first case of leukoencephalopathy caused by buprenorphine ingestion in a 2-year-old child who was admitted for coma and fever. Due to technical problems, the toxicology screen was delayed, and infectious disease was first suspected. A brain MRI found bilateral and symmetric white matter damages in the cerebral hemispheres and the cerebellum. Rapid recovery and positive toxicology screen for buprenorphine on day 4 confirmed the diagnosis of acute intoxication.

Methadone-induced toxic leukoencephalopathy: diagnosis and follow-up by magnetic resonance imaging including diffusion-weighted imaging and apparent diffusion coefficient maps

BACKGROUND AND PURPOSE

Effects of methadone misuse have been rarely described. The purpose of this case report is to increase the knowledge of methadone-related leukoencephalopathy.

METHODS

We report the long-term follow-up by brain magnetic resonance imaging including isotropic diffusion-weighted imaging and mean apparent diffusion coefficient values of a 49-year-old patient who attempted suicide by intravenous methadone.

RESULTS AND CONCLUSIONS

Lesion pattern included subtle cerebellar involvement, mainly reversible extensive bilateral and symmetric brain involvement, cystic degeneration in the periventricular regions, sparing of corpus callosum and subcortical U-fibers, development of diffuse brain atrophy, and clear-cut clinical improvement.