heroin and Brain-Damage--Chronic

There are several complications associated with heroin abuse, some of which are life-threatening. Methadone may aggravate this problem.. A clinical case description.. A 33-year-old man presented with rhabdomyolysis and cerebral ischemic stroke after intravenous heroin. He had used heroin since age 20, and had used 150 mg methadone daily for 6 months. He was found unconsciousness at home and was sent to our hospital. In the ER, his opiate level was 4497 ng/ml. In the ICU, we found rhabdomyolysis, acute renal failure and acute respiratory failure. After transfer to an internal ward, we noted aphasia and weakness of his left limbs. After MRI, we found cerebral ischemic infarction.. Those using methadone and heroin simultaneously may increase risk of rhabdomyolysis and ischemic stroke. Patients under methadone maintenance therapy should be warned regarding these serious adverse events. Hypotheses of heroin-related rhabdomyolysis and stroke in heroin abusers are discussed.

Topics: Adult; Brain; Brain Damage, Chronic; Cerebral Cortex; Cerebral Hemorrhage; Cerebral Infarction; Dominance, Cerebral; Drug Interactions; Electroencephalography; Heroin; Heroin Dependence; Humans; Intensive Care Units; Magnetic Resonance Imaging; Male; Methadone; Narcotics; Rhabdomyolysis; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Tomography, X-Ray Computed

Topics: Administration, Inhalation; Ataxia; Brain; Brain Damage, Chronic; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Memory Disorders; Middle Aged; Narcotics; Nerve Fibers, Myelinated; Neurotoxicity Syndromes; Reflex, Abnormal

Three cases of hypoxic-ischemic leukoencephalopathy were studied. In two patients, the neurologic disorder followed drug overdosage; in the third, the apparent precipitating event was a postoperative myocardial infarction complicated by circulatory insufficiency. All patients were deeply unresponsive, with varying reflex patterns. In all three cases, the brain showed extensive symmetrical necrotic lesions of the central white matter, with minimal damage to gray matter structures. The lesions in case 3 showed, in addition, vascular necrosis and ring hemorrhages. Common to all cases was a prolonged period of hypoxemia, hypotension, and elevated venous pressure. Acidosis occurred in two. These observations and analysis of previous reports of similar cases suggest that leukoencephalopathy tends to occur when the hypoxemia is prolonged and is associated with periods of hypotension and metabolic imbalance.

Topics: Adult; Aged; Brain; Brain Damage, Chronic; Female; Glutethimide; Heroin; Humans; Hypotension; Hypoxia, Brain; Ischemia; Male; Myocardial Infarction

Topics: Adolescent; Adult; Brain; Brain Damage, Chronic; Endocarditis, Bacterial; Female; Heroin; Humans; Male; Myelitis; New York City; Polyneuropathies; Substance-Related Disorders; Tetanus