Fentanyl-induced brain damage may be missed because fentanyl is not routinely included in standard drug tests, and diagnosis requires MRI, researchers cautioned.
"While heroin has been the principal opiate associated with TLE, this case highlights the importance of recognizing other opiates such as fentanyl as potentially causative," Christopher Eden, MD, a second-year resident in internal medicine at the Oregon Health & Science University School of Medicine, who was part of the patient's treatment team, toldPrevious case reports have shown that opiates, mainly heroin, may lead to TLE.
Crushed pills and white residue were found on a nearby table, and TLE induced by inhaling heroin was initially suspected. "Fentanyl is not routinely tested on all urine drug tests; thus, providers need to be suspicious of its presence and to work with their local laboratories to have it added to the standard drug testing platforms," Eden toldBrain MRI revealed reduced diffusivity and fluid-attenuated inversion recovery hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum, and globus pallidus.
"Often times, fentanyl cases like this presenting to the ED may be incorrectly attributed to hypoxic brain injury due to opioids causing respiratoryand low oxygen levels. Importantly, hypoxic brain injury and toxic leukoencephalopathy are distinct pathologies, which require MRI imaging," Eden noted.
Toxicity Poisoning Toxins Opioids Addiction Leukoencephalopathy Leukoencephalopathies Brain Opiate Encephalopathy Injury Neuroimaging Preventive Screening Screening Erectile Dysfunction Impotence ED Erectile Dysfunction (ED) Wound Management Wound Care Depression Tobacco Cessation Quitting Tobacco Use Smoking Cessation Opioid Abuse Abuse Hospitals Intravenous
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