Opioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definition

Barash, Jed A.; Whitledge, James D.; Watson, C. James; Boyle, Katherine; Lim, Chun Soo; Lev, Michael H.; DeMaria, Alfred; Ganetsky, Michael

doi:10.1016/j.jns.2020.117048

Cited by 26 publications

(28 citation statements)

References 18 publications

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“…Of the 40 patients identified, there were 20 confirmed, 10 probable, and 10 possible OAS cases. Our patient meets all diagnostic criteria for "confirmed OAS" [17].…”

Section: Discussionmentioning

confidence: 69%

“…Barash et al recently established a formal definition for this opioid-associated amnestic syndrome (OAS), defined as acute onset memory loss lasting more than 24 hours and bilateral hippocampal signal abnormalities on brain imaging in the setting of opioid use. They also validated a set of diagnostic criteria for "confirmed," "probable," and "possible" OAS, based on 40 unique cases of bilateral hippocampal diffusion restriction identified within the literature [17]. All cases consist of a new onset amnesia lasting at least 24 hours.…”

Section: Discussionmentioning

confidence: 99%

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Complete Bilateral Hippocampal Diffusion Restriction and Reversible Amnesia Following Opiate, Cocaine, and Benzodiazepine Abuse

Huang

Lukas

2021

Cureus

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The hippocampus is a crucial component of the circuits involved in memory formation and recall. Bilateral hippocampal lesions can lead to profound anterograde amnesia. As a highly vascularized structure, the hippocampus is susceptible to ischemia from hypoxic and toxic insults. Infarction of bilateral hippocampi as a result of cocaine use, while rare, is well described in the literature. Combined opiate and stimulant abuse also cause dysfunction of this structure. We present a case of complete bilateral hippocampal diffusion restriction and anterograde amnesia after heroin, cocaine, and benzodiazepine abuse, consistent with opioid-associated amnestic syndrome, as well as a remarkable resolution of amnesia months later.

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“…Of the 40 patients identified, there were 20 confirmed, 10 probable, and 10 possible OAS cases. Our patient meets all diagnostic criteria for "confirmed OAS" [17].…”

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Complete Bilateral Hippocampal Diffusion Restriction and Reversible Amnesia Following Opiate, Cocaine, and Benzodiazepine Abuse

Huang

Lukas

2021

Cureus

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“…This patient demonstrated new-onset amnesia of duration greater than 24 h and bilateral hippocampal injury in the setting of confirmed opiate use. After an extensive workup to exclude alternative etiologies, he was diagnosed with the newly characterized OAS [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…A cluster of 18 cases of opioid-associated amnestic syndrome (OAS) from Massachusetts between 2012 and 2018 was defined by amnesia with bilateral hippocampal injury in association with opioid use [1][2][3]. A total of 40 confirmed, probable, or possible cases were identified on a subsequent systematic review; the cohort was multi-national and included iatrogenic opioid use as well.…”

Section: Introductionmentioning

confidence: 99%

“…By the authors’ criteria, all the cases were characterized by amnesia for greater than 24 h duration and were considered confirmed if there were positive toxicology for opioid and bilateral hippocampal injury on brain imaging; probable if there were known history of opioid use and the mentioned imaging finding; possible if there was one of the following: positive toxicology for an opioid, known history of opioid use, or imaging finding. Based on the case definition, 20 of their 40 cases were considered confirmed [ 1 ]. The purpose of this study is to report an additional confirmed case of OAS.…”

Section: Introductionmentioning

confidence: 99%

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Opioid-Associated Amnestic Syndrome

Ciurylo

Noh

2021

Cureus

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A 31-year-old male with a history significant for obesity, attention deficit hyperactivity disorder, methamphetamine use, and IV drug use was evaluated for unexplained global amnesia greater than 24 h. The patient had been in recovery for opioid use disorder for about a year, but he relapsed on IV fentanyl in the week prior to presentation. On exam, he was alert and fully oriented but had no spontaneous recall of three objects after five minutes. General medical and neurological examinations were otherwise unrevealing. Urine fentanyl and norfentanyl were positive. CT and MRI imaging demonstrated isolated bilateral hippocampal injury. Given the totality of his presentation and the contributing variables, his medical team considered this to be a case of the newly characterized opioid-associated amnestic syndrome (OAS). This case is significant because of the relative absence of potentially confounding variables on presentation, including antecedent cardiorespiratory failure. Further reporting of these cases may have implications for understanding opioid toxicity and clarifying the functional role of the hippocampus.

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