Bilateral Basal Ganglia Lesions in Patients with Heroin Overdose: A Report of Two Cases

Abstract

The prevalence of opioid use has increased worldwide. Two-thirds of deaths caused by drug overdose are opioid-related. Individuals with opioid use may present with a variety of complications. The available history in unconscious patients is often insufficient, which may cause diagnostic difficulty and delayed management. We present two cases of 54-year-old and 25year-old male patients who were brought to our emergency department after being found unconscious at home, without any known preceding event. They were in a deep coma with a Glasgow coma score of 3/15. However, their brainstem reflexes were normal. Pinpoint pupils were observed bilaterally. Brain computed tomography (CT) demonstrated the presence of bilateral basal ganglia hypodensities in both patients, in addition to multiple hypodensities scattered in the cerebral hemispheres of one patient. Toxicology screening from both patients was positive for opioids. The patients were transferred to the intensive care unit for supportive management. One patient recovered completely, whereas the other remained in a vegetative state. The presence of bilateral basal ganglia lesions in brain CT in unconscious patients should alert the physician of opioid use disorder among these patients.

Chronic heroin use disorder and the brain: Current evidence and future implications

“…Heroin use disorder and the brain: current evidence and future implications 10 is the increased risk of non-fatal overdoses and consequent hypoxic cerebral damage (Hassan et al, 2019;Pearson et al, 1976;Trescot et al, 2008).…”