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Open Access 01-12-2021 | Magnetic Resonance Imaging | Case report

Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments

Authors: Jonathan Repple, Svea Haessner, Andreas Johnen, Nils C. Landmeyer, Andreas Schulte-Mecklenbeck, Marc Pawlitzki, Heinz Wiendl, Gerd Meyer zu Hörste

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone–use and –abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare.

Case presentation

Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid.

Conclusion

This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone.

Available only for authorised users

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Title: Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments
Authors: Jonathan Repple
Svea Haessner
Andreas Johnen
Nils C. Landmeyer
Andreas Schulte-Mecklenbeck
Marc Pawlitzki
Heinz Wiendl
Gerd Meyer zu Hörste
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Opioids
Intoxication
Opioids
Methadone
Encephalopathy
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02108-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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