heroin and Brain-Edema

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.. 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.. 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.. 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.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Basal Ganglia; Benzodiazepines; Brain Edema; Central Nervous System Stimulants; Cerebellar Cortex; Cerebellum; Cocaine; Coma; Female; Heroin; Hippocampus; Humans; Hydrocephalus; Hydromorphone; Magnetic Resonance Imaging; Male; Middle Aged; Opiate Alkaloids; Pain, Postoperative; Stupor; Substance-Related Disorders; Syndrome

To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).. PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy.. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis.. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death.. Frequent findings in cases of fatal opioid intoxication were investigated. Lung oedema, brain oedema and full urinary bladder represent a highly specific constellation. This combination of findings in post-mortem CT should raise suspicion of intoxication.

Topics: Adolescent; Adult; Autopsy; Brain Edema; Cardiomegaly; Cause of Death; Female; Forensic Pathology; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Narcotics; Pulmonary Edema; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Urinary Bladder; Whole Body Imaging; Young Adult

We report a case of death due to heroin leakage in a body packer, attempting to smuggle the drug by concealing it in his gastro-intestinal tract. The body was recovered 3-5 days of incidence that was confirmed by autopsy. Fifty pellets (packages) were recovered from the body, 42 identical oval shaped "egg" packages were found in the stomach out of which two were damaged, 6 in small intestine, 2 in large intestine. The total weight of the powder was 267 g. Toxicological analysis of the powder samples from the damaged package and other 48 packages was performed and was found positive for heroin, caffeine and codeine. The main pathological findings at autopsy were pulmonary and cerebral edema. This case illustrates the challenges in postmortem evaluation of narcotic fatalities and the need to consider factors such as ante-mortem history, thorough post mortem examination, toxicology results and photography in forensic diagnosis. This case is unique in the sense that cause of death was intoxication caused by leakage of heroin from damaged packages detected at autopsy and demonstrates that body packing is an existing problem in India.

Topics: Adult; Brain Edema; Crime; Drug Packaging; Foreign Bodies; Forensic Pathology; Heroin; Humans; India; Intestine, Large; Intestine, Small; Male; Narcotics; Stomach

Serious leukoencephalopathy can be related to heroin injection or inhalation.. We report the first case of leukoencephalopathy observed three weeks after a 46-year-old man sniffed heroin. The clinical presentation included cognitive and behaviour disorders, pyramidal irritation and slight gait instability. Blood and cerebrospinal fluid analyse were normal. Brain magnetic resonance imaging showed diffuse, symmetrical supratentorial white matter lesions producing high intense signals on FLAIR and b1000-weighted sequences. Proton spectroscopy revealed an increased rate of cholin, in favour of active demyelinated lesions. Brain biopsy showed intramyelinic oedema with reactive gliosis. After two and a half years, moderate attentional fluctuations and difficulties in initiating activities persisted. Repeated MRI showed a reduction of the leukoencephalopathy.. Heroin could be a cause more common than thought of leukoencephalopathy. The clinical and radiological expression and prognosis could be related to the mode of consummation (inhalation, intravenous injection, sniffing). This parameter may modulate severity and localization of brain lesions. More systematic use of MRI for patients with psychiatric symptoms after heroin intoxications could lead to a better evaluation of heroin-related neurotoxicity and potentially improve prevention.

Topics: Administration, Inhalation; Biopsy; Brain Chemistry; Brain Edema; Choline; Cognition Disorders; Demyelinating Diseases; Gliosis; Heroin; Heroin Dependence; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Male; Middle Aged; Narcotics; Prognosis

We report a case of death due to the effects of heroin concealed in a woman who was attempting to smuggle the drug into Kenya concealed within her gastro-intestinal tract. She was arrested at a Nairobi airport. While under police detention, she expelled a pellet par anum containing the drug then collapsed, after being forcefully fed on a heavy meal. She was taken to hospital in coma where she expelled nine pellets and died three days later. Her blood level of heroin at admission was well beyond the lethal dose. Details are provided of the circumstances leading to her admission into hospital, her stay in hospital and the autopsy findings. At autopsy 88 pellets were retrieved from her body. The main pathological findings included pulmonary and cerebral edema. Despite the presence of free heroin in the gastric contents, toxicological analysis did not demonstrate any heroin or its metabolites in blood or tissue extracts. This case illustrates the challenges in postmortem evaluation of narcotic fatalities and the need to consider all factors such as antemortem history, toxicology results and autopsy findings in forensic diagnosis

Topics: Adult; Autopsy; Brain Edema; Coma; Drug Implants; Fatal Outcome; Female; Gastrointestinal Tract; Heroin; Humans; Kenya; Pulmonary Edema; Syndrome

Topics: Adolescent; Adult; Brain Edema; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Male; Pulmonary Edema; Pulmonary Embolism

Topics: Adolescent; Adult; Brain Abscess; Brain Edema; Cerebral Hemorrhage; Deafness; Heroin; Humans; Male; Meningitis; Myelitis, Transverse; Myoglobinuria; Myositis; Neuritis; Neurocognitive Disorders; Polyradiculopathy; Substance-Related Disorders; Tetanus