An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use
Authors: Uzoma B. Duru, Gauri Pawar, Jed A. Barash, Liv E. Miller, Indrani K. Thiruselvam, Marc W. Haut
Journal: Annals of Internal Medicine (2018)

Letters15 May 2018An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine UseUzoma B. Duru, MD, Gauri Pawar, MD, Jed A. Barash, MD, Liv E. Miller, PsyD, Indrani K. Thiruselvam, PhD, and Marc W. Haut, PhDUzoma B. Duru, MDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Gauri Pawar, MDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Jed A. Barash, MDSoldiers' Home, Chelsea, Massachusetts (J.A.B.), Liv E. Miller, PsyDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Indrani K. Thiruselvam, PhDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), and Marc W. Haut, PhDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0575 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Between 2012 and 2016, a total of 14 persons in Massachusetts with a history of substance use developed an unusual amnestic syndrome that included acute, complete, and bilateral hippocampal lesions on magnetic resonance imaging (1).Objective: To describe an additional patient whose characteristics may extend our understanding of this syndrome.Case Report: In May 2017, a 30-year-old man was transferred from a local hospital in his native Maryland to a tertiary medical center in West Virginia for persistent memory impairment. According to family members, the patient had a history of heroin use, was recently discharged from a residential addiction ...References1. Barash JA, Somerville N, DeMaria A. Cluster of an unusual amnestic syndrome—Massachusetts, 2012-2016. MMWR Morb Mortal Wkly Rep. 2017;66:76-9. [PMID: 28125568] doi:10.15585/mmwr.mm6603a2 CrossrefMedlineGoogle Scholar2. Haut MW, Hogg JP, Marshalek PJ, Suter BC, Miller LE. Amnesia associated with bilateral hippocampal and bilateral basal ganglia lesions in anoxia with stimulant use. Front Neurol. 2017;8:27. [PMID: 28228745] doi:10.3389/fneur.2017.00027 CrossrefMedlineGoogle Scholar3. Massachusetts Department of Public Health. Data brief: an assessment of opioid-related deaths in Massachusetts (2013-2014). Accessed at www.mass.gov/eohhs/docs/dph/stop-addiction/chapter-55-opioid-overdose-study-data-brief-9-15-2016.pdf on 10 September 2017. Google Scholar4. Connelly KL, Chen X, Kwan PF. Bilateral hippocampal stroke secondary to acute cocaine intoxication. Oxf Med Case Reports. 2015;2015:215-7. [PMID: 26634127] doi:10.1093/omcr/omv016 CrossrefMedlineGoogle Scholar5. Kofke WA, Garman RH, Stiller RL, Rose ME, Garman R. Opioid neurotoxicity: fentanyl dose-response effects in rats. Anesth Analg. 1996;83:1298-306. [PMID: 8942603] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)Soldiers' Home, Chelsea, Massachusetts (J.A.B.)Note: The authors report no potential conflicts of interest and have received no financial, material, or other support for this project.Acknowledgment: The authors thank Dr. Alfred DeMaria Jr. at the Massachusetts Department of Public Health for his critical review of the manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0575.This article was published at Annals.org on 30 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAn Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use Uzoma B. Duru , Gauri Pawar , Jed A. Barash , Liv E. Miller , Indrani K. Thiruselvam , and Marc W. Haut An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use Todd Davies Metrics Cited byNeurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic reviewConsumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North CarolinaAssessing Memory Loss in a Young Adult with Substance Use Disorder: Remember the Timing of PresentationOpioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definitionNeurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a ReviewAn Opioid-Related Amnestic Syndrome With Persistent Effects on Hippocampal Structure and FunctionAn Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine UseTodd Davies, PhDFentanylAcute Amnestic Syndrome Associated with Fentanyl OverdoseConnecting the dots: an association between opioids and acute hippocampal injury 15 May 2018Volume 168, Issue 10Page: 747-748KeywordsAmnesiaBrainCocaineDrugsLesionsMagnetic resonance imagingMetabolitesOpioidsToxicologyUrine ePublished: 30 January 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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