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September 15, 2009; 73 (11) Articles

Embolic stroke associated with injection of buprenorphine tablets

C. C. Tchoyoson Lim, Sze Haur Lee, Yee-Choon Wong, Francis Hui
First published September 14, 2009, DOI: https://doi.org/10.1212/WNL.0b013e3181b784c0
C. C. Tchoyoson Lim
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Sze Haur Lee
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Yee-Choon Wong
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Francis Hui
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Citation
Embolic stroke associated with injection of buprenorphine tablets
C. C. Tchoyoson Lim, Sze Haur Lee, Yee-Choon Wong, Francis Hui
Neurology Sep 2009, 73 (11) 876-879; DOI: 10.1212/WNL.0b013e3181b784c0

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Abstract

Background: Drug users who crush, dissolve, and inject buprenorphine tablets parenterally may be at risk of severe thromboembolic complications or death. We describe patients with neurologic complications after injecting buprenorphine tablets.

Methods: Brain MRI including diffusion-weighted imaging (DWI) in patients admitted to the neurologic department after injecting buprenorphine tablets were reviewed.

Results: Seven men had neurologic complications after buprenorphine tablet injection. In 5 patients, multiple small scattered hyperintense lesions were detected on DWI in the cortex, white matter, and basal ganglia of the cerebral hemisphere; one patient had a single small lesion. The side of MRI abnormality corresponded to the side of needle marks on the neck except in one patient who had bilateral injections. One patient, who denied injecting into the neck, had DWI abnormalities in the middle cerebral artery territory on one side and occlusion of the ipsilateral internal carotid artery.

Conclusions: Buprenorphine tablets can be intentionally or inadvertently injected into the carotid artery, causing a characteristic appearance on diffusion-weighted imaging, consistent with embolic cerebral infarction.

Glossary

DWI=
diffusion-weighted imaging;
ICA=
internal carotid artery;
MCA=
middle cerebral artery;
MRC=
Medical Research Council.
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Disputes & Debates: Rapid online correspondence

  • Embolic stroke associated with injection of buprenorphine tablets
    • E. Douglas Kramer, Kensington Pharmaceuticals, LLC, 71 Kensington Rd, Stamford, CT 06905kramered@juno.com
    • Nabarun Dasgupta, MPH (University of North Carolina at Chapel Hill)
    Submitted November 10, 2009
  • Reply from the authors
    • CC Lim, Department of Neuroradiology, National Neuroscience Institute,, 11 Jalan Tan Tock Tock Seng, Singapore 308433tchoyoson_lim@nni.com.sg
    • Lee SH, Wong YC, Hui F.
    Submitted November 10, 2009
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