Can inhaled heroin be a cause of bilateral globus pallidus ischemic injury?

Abstract

Introduction Bilateral globus pallidus lesions have been characteristically thought to be associated with global cerebral hypoperfusion and hypoxic changes. One of the important causative factors that need to be considered is the opiate drug abuse. Case presentation We present a case of a 50-year-old male who came to the hospital after being found down for 3 hours. He was found to have weakness of right upper and lower extremity. MRI showed bilateral globus pallidus infarcts. He later admitted to inhalation of heroin. Over the next few days, weakness started to improve and he was eventually discharged to rehabilitation. This case is a unique presentation of bilateral globus pallidus lesions after a one-time inhalation of heroin. Conclusion We, therefore, advocate that inhaled heroin should be considered as one of the causes of bilateral globus pallidus lesions, in addition to IV heroin and cocaine and physicians should be aware of the possibility of alternate forms of heroin abuse in such patients.

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

“…Son áreas de alta densidad axonal, actuando como centro de conjunción de vías de neurotransmisión por dopamina, glutamato y GABA (13,18). Dada la complejidad de los circuitos neuronales que confluyen a nivel subcortical, ganglio basal y talámico, usualmente se requiere una lesión bilateral y sincrónica para general alteraciones clínicamente evidentes (16,19,20,21); Tabla 1. Conjunto de hallazgos patológicos en neuroimágenes asociados con la intoxicación aguda y crónica por medicamentos opioides.…”

“…presentándose de esta forma y con cierta frecuencia en escenarios de choque profundo y sostenido, así como en situaciones de hipoxia grave descritas durante la intoxicación por monóxido de carbono, cocaína, heroína y otros opioides (12,13,20,21). Por lo anterior, dicha lesión representa un diagnóstico diferencial de especial relevancia en los pacientes quienes luego de una sobredosis por opioides, desarrollan de forma aguda síntomas cognitivos, afectivos y/o motores no explicados por el efecto de las sustancias exógenas involucradas.…”

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

“…In an autopsy study by Andersen and Skullerud [7] involving 100 individuals who were intravenous heroin users, it was concluded that around 5–10% of users may have had pallidal infarcts with or without other cerebral injuries. Of note, the basal ganglia changes were reported in individuals who used inhaled heroin and other opioids such as methadone [8, 9].…”