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Methadone-Induced Encephalopathy: A Case Series and Literature Review
Hossein Hassanian-Moghaddam
Shahid Beheshti University of Medical Sciences School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4370-0544
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Imaging.
Background: Accidental ingestion or consumption of supra-therapeutic doses of methadone can result in neurological sequelae in humans. We aimed to determine the neurological deficits of methadone-poisoned patients admitted to a referral poisoning hospital using brain magnetic resonance (MR) and diffusion weighted (DW) imaging.
Methods: In this retrospective study, brain MRIs of the patients admitted to our referral center due to methadone intoxication were reviewed. Methadone intoxication was confirmed based on history, congruent clinical presentation, and confirmatory urine analysis . Each patient had an MRI with Echo planar T1, T2, FLAIR, and DWI and apparent deficient coefficient (ADC) sequences without contrast media. Abnormalities were recorded and categorized based on their anatomic location and sequence.
Results: Ten patients with abnormal MRI findings were identified. Eight had acute- and two had delayed-onset encephalopathy. Imaging findings included bilateral confluent or patchy T2 and FLAIR high signal intensity in cerebral white matter, cerebellar involvement, and bilateral occipito-parietal cortex diffusion restriction in DWI. Internal capsule involvement was identified in two patients while abnormality in globus pallidus and head of caudate nuclei were reported in another. Bilateral cerebral symmetrical confluent white matter signal abnormality with sparing of subcortical U-fibers on T2 and FLAIR sequences were observed in both patients with delayed-onset encephalopathy.
Conclusions : Acute- and delayed-onset encephalopathies are two rare adverse events detected in methadone-intoxicated patients. Brain MRI findings can be helpful in detection of methadone-induced encephalopathy.
Keywords
Methadone, acute encephalopathy, delayed leukoencephalopathy, magnetic resonance imaging
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CURRENT STATUS: Published
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Posted 08 Jan, 2020
Published
On 17 Jan, 2020
No community comments so far
Submission checks complete
On 04 Jan, 2020
Editorial decision: Accept
On 03 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 31 Dec, 2019
Review #1 received
Received 22 Nov, 2019
Reviewer #2 agreed
On 22 Nov, 2019
Review #2 received
Received 22 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Editor assigned
On 18 Nov, 2019
Submission checks complete
On 17 Nov, 2019
Editor invited
On 17 Nov, 2019
No comments provided
Review #1 received
Received 06 Nov, 2019
Editorial decision: Major revision
On 06 Nov, 2019
Review #2 received
Received 23 Oct, 2019
Reviewer #2 agreed
On 20 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Reviewer #1 agreed
On 14 Oct, 2019
Submission checks complete
On 02 Oct, 2019
Editor assigned
On 02 Oct, 2019
Editor invited
On 01 Oct, 2019
First submitted
On 27 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nuclear Medicine & Medical Imaging
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This preprint is under consideration at BMC Medical Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Methadone-Induced Encephalopathy: A Case Series and Literature Review
Hossein Hassanian-Moghaddam
Shahid Beheshti University of Medical Sciences School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4370-0544
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 08 Jan, 2020
Published
On 17 Jan, 2020
No community comments so far
Submission checks complete
On 04 Jan, 2020
Editorial decision: Accept
On 03 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 31 Dec, 2019
Review #1 received
Received 22 Nov, 2019
Reviewer #2 agreed
On 22 Nov, 2019
Review #2 received
Received 22 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Editor assigned
On 18 Nov, 2019
Submission checks complete
On 17 Nov, 2019
Editor invited
On 17 Nov, 2019
No comments provided
Review #1 received
Received 06 Nov, 2019
Editorial decision: Major revision
On 06 Nov, 2019
Review #2 received
Received 23 Oct, 2019
Reviewer #2 agreed
On 20 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Reviewer #1 agreed
On 14 Oct, 2019
Submission checks complete
On 02 Oct, 2019
Editor assigned
On 02 Oct, 2019
Editor invited
On 01 Oct, 2019
First submitted
On 27 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nuclear Medicine & Medical Imaging
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Imaging.
Background: Accidental ingestion or consumption of supra-therapeutic doses of methadone can result in neurological sequelae in humans. We aimed to determine the neurological deficits of methadone-poisoned patients admitted to a referral poisoning hospital using brain magnetic resonance (MR) and diffusion weighted (DW) imaging.
Methods: In this retrospective study, brain MRIs of the patients admitted to our referral center due to methadone intoxication were reviewed. Methadone intoxication was confirmed based on history, congruent clinical presentation, and confirmatory urine analysis . Each patient had an MRI with Echo planar T1, T2, FLAIR, and DWI and apparent deficient coefficient (ADC) sequences without contrast media. Abnormalities were recorded and categorized based on their anatomic location and sequence.
Results: Ten patients with abnormal MRI findings were identified. Eight had acute- and two had delayed-onset encephalopathy. Imaging findings included bilateral confluent or patchy T2 and FLAIR high signal intensity in cerebral white matter, cerebellar involvement, and bilateral occipito-parietal cortex diffusion restriction in DWI. Internal capsule involvement was identified in two patients while abnormality in globus pallidus and head of caudate nuclei were reported in another. Bilateral cerebral symmetrical confluent white matter signal abnormality with sparing of subcortical U-fibers on T2 and FLAIR sequences were observed in both patients with delayed-onset encephalopathy.
Conclusions : Acute- and delayed-onset encephalopathies are two rare adverse events detected in methadone-intoxicated patients. Brain MRI findings can be helpful in detection of methadone-induced encephalopathy.
Figure 1
Figure 2
Figure 3
Figure 4