Cluster of an Unusual Amnestic Syndrome — Massachusetts, 2012–2016

Barash, Jed A.; Somerville, Nick; DeMaria, Alfred

doi:10.15585/mmwr.mm6603a2

Cited by 51 publications

(73 citation statements)

References 10 publications

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“…A case series and subsequent alert by the Massachusetts Department of Public Health identified 13 cases of an opioid-associated amnestic syndrome between 2012 and 2016. 1 Patients had acuteonset amnesia and evidence of opioid use on history or toxicology. All patients had a single MRI study by day 8 that showed bilateral hippocampal restricted diffusion, in keeping with infarction.…”

Section: Discussionmentioning

confidence: 99%

Opioid-associated amnestic syndrome observed with fentanyl patch use

Taylor

Budhram

Lee

et al. 2019

CMAJ

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A 63-year-old woman with a history of multiple sclerosis and chronic musculoskeletal pain was found unresponsive in bed by her husband at about 1100 h. A year prior, the patient had been prescribed fentanyl patches for postoperative pain, which she did not use. Her usual daily medications included hydromorphone 9 mg 3 times per day, zopiclone 7.5 mg every night at bedtime and pregabalin 75 mg twice per day, all of which had been taken at the same dose at which they had been used for the last year, except for the hydromorphone. In the weeks before her presentation to hospital, the patient had not been taking her hydromorphone as prescribed because of adverse effects. At about 2300 h the evening before her arrival in the emergency department, the patient had reported increasing pain and applied three 12 µg fentanyl patches, doubling her daily morphine equivalent dose by the time she was found unresponsive 12 hours later. Her husband performed 10 minutes of cardiopulmonary resuscitation without checking for a pulse. When paramedics arrived, the patient had a pulse of 91 beats/min and was in normal sinus rhythm, with a blood pressure reading of 94/57 mm Hg and oxygen saturation of 84%. She awoke after naloxone infusion in the emergency department. Toxicology screening was positive for opiates only. Routine serology testing showed mild transient elevation in transaminase, troponin and creatine kinase levels. Over the following days, the patient showed profound anterograde amnesia and was unable to recall daily autobiographical details, despite meticulously recording them in a journal (Figure 1).Neurologic examination identified anisocoria and mild spastic paraparesis, which were unchanged from a previously documented examination 3 years earlier. Her Montreal Cognitive Assessment score was 19/30: she lost 3 points for date, month and day; 5 points on delayed recall despite intact immediate recall; and 1 point on each of trails, cube and repetition. No prior cognitive testing was available for comparison. Gadolinium-enhanced magnetic resonance imaging (MRI) of the head performed on day 7 showed striking bilateral gyriform hippocampal hyperintensity on T 2 -weighted imaging with corresponding restricted diffusivity on diffusion-weighted imaging (Figure 2), in addition to white-matter lesions compatible with multiple sclerosis that were stable on comparison with previous imaging. Electroencephalography done the same day showed no epileptiform activity. The patient's cerebrospinal fluid profile was unremarkable, and results of polymerase chain reaction testing for herpes simplex virus were negative. Results of testing for arbovirus and syphilis, and a routine paraneoplastic antibody panel were also negative.Magnetic resonance imaging of the head on day 12 showed complete resolution of the previously seen hippocampal diffusion PRACTICE | CASES VULNERABLE POPULATIONS CPD

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Section: Discussionmentioning

confidence: 99%

Opioid-associated amnestic syndrome observed with fentanyl patch use

Taylor

Budhram

Lee

et al. 2019

CMAJ

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“…Schwere amnestische Syndrome treten auf, wenn auch der kontralateral zur Resektion liegende Hippocampus beeinträchtigt ist. Eine akute und komplette Ischämie beider Hippocampi führt zu einer anterograden Amnesie [4]. Die klinische Bedeutung intakter mediotemporaler Strukturen wurde durch den Fall des Patienten H. M. deutlich [5], der starke deklarative Gedächtniseinbußen im Sinne einer anterograden Amnesie nach bilateraler Entfernung des Hippocampus zur Epilepsiebehandlung aufwies.…”

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“…In einer neueren Arbeit aus dem Jahr 2017 wurden 14 Fälle im Alter von 19-52 Jahren mit plötzlich beginnender Amnesie durch akute, komplette und bilaterale Ischämie der Hippocampusregion publiziert [4]. Eine eindeutige Ätiologie ließ sich nicht belegen, aber 13 der Patienten wurden positiv auf Opioide getestet bzw.…”

Section: Abgrenzungunclassified

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Amnestische Syndrome

Wietelmann¹

2020

PSYCH up2date

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“…4 Peculiarly, another reported reversible hypoxia/hypoglycaemia model comparing various opioid types demonstrated a negative effect of morphine but not fentanyl, 5 which is contradicted by the clinical literature in humans showing this can occur with various opioids among other substances. 6 It is also possible that an interaction of various substances increases the likelihood of this complication, as has been suggested by numerous reports. [6][7][8] A unique feature of our case is the availability of follow-up imaging that demonstrated a delayed-onset diffuse leukoencephalopathy with partial improvement at 5-month follow-up imaging.…”

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confidence: 91%