Clinical and radiological findings in methadone-induced delayed leukoencephalopathy
Sammanfattning
OBJECTIVE: To increase awareness of the incidence of delayed leukoencephalopathy in
rehabilitation medicine.
Subject: A 34-year-old male patient in an inpatient neuro-rehabilitation clinic who developed
cognitive, psychological and physical deterioration 33 days after methadone intake.
METHODS: Clinical follow-up for 7 months, brain imaging with magnetic resonance imaging and
computed tomography, electroencephalography, multidisciplinary team evaluation and rehabilitation,
pharmacological treatment, and examination of medical records.
RESULTS: Clinical findings showed neuropsychological and motor deterioration. Brain images
demonstrated that previous white matter infarctions had developed to cystic substance defects, and
that abnormally high signals developed in the white matter of most cerebral lobes, with the exception
of the grey matter and the cerebellum. Clinical improvement coincided with a modification in
pharmacological treatment (increase in sertraline and introduction of baclofen). Brain images at 3 and
6 months after the methadone overdose showed reduced intensity of signal abnormalities and
complete normalization of diffusion weighted images. Evaluation 7 months after injury estimated
moderate brain injury with moderate disability and partial recovery of the patient’s capacity for
previous activities of daily living.
CONCLUSION: Delayed leukoencephalopathy should be suspected in patients who deteriorate after
methadone overdose. Drugs such as sertraline and baclofen may be of use in treating delayed
leukoencephalopathy.