Acute Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, Lancashire, UK
Acute Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, Lancashire, UK.
BMJ Case Rep. 2023 Sep 27;16(9):e255291. doi: 10.1136/bcr-2023-255291.
Toxic leukoencephalopathy (TLE) is a rare pathology caused by various substances including opioids (notably heroin), immunosuppressants, chemotherapy agents, cocaine, alcohol and carbon monoxide. However, although heroin is metabolised by the body into morphine, there is a striking paucity in cases of primary oral morphine-induced TLE, especially in the adult population. We present the case of a man in his 40s admitted to hospital in respiratory depression with a Glasgow Coma Scale (GCS) score of 6 after taking an overdose of oral morphine sulphate. Following a complete recovery to baseline, he was then readmitted with an acute deterioration in his neurobehavioural condition. Initial investigations returned normal but MRI showed changes characteristic for TLE.In cases of opioid toxicity such as ours, TLE is difficult to differentiate from delayed post-hypoxic leukoencephalopathy, due to their similar clinical presentation, disease progression and radiological manifestation. We explore how clinicians can approach this diagnostic uncertainty.
中毒性脑白质病（TLE）是一种由多种物质引起的罕见疾病，包括阿片类药物（特别是海洛因）、免疫抑制剂、化疗药物、可卡因、酒精和一氧化碳。然而，尽管海洛因在体内代谢为吗啡，但原发性口服吗啡引起的 TLE 病例极为罕见，特别是在成年人群中。我们报告了一名 40 多岁男子的病例，他因口服硫酸吗啡过量导致呼吸抑制而住院，格拉斯哥昏迷评分（GCS）为 6 分。在完全恢复到基线后，他因神经行为状况急性恶化再次入院。初步检查结果正常，但 MRI 显示出 TLE 的特征性变化。在我们这样的阿片类药物中毒的情况下，由于其临床表现、疾病进展和影像学表现相似，TLE 很难与迟发性缺氧性脑白质病区分开来。我们探讨了临床医生如何处理这种诊断上的不确定性。
