Unusual Amnestic Syndrome Associated with Combined Fentanyl and Cocaine Overdose (P1.200)

Objective: NA Background: A 30 year-old man was “found down” by a family member with drug paraphernalia next to his bed. The patient has a history of mood disorder and IV drug use and had completed a 35-day drug rehab program prior to his presentation. His drug of choice was heroine. He remained confused, asked repetitive quest, and has no recollection of the events of that day. Urine drug screen (UDS) at the outside facility was positive for cocaine. A non-contrasted computed tomography (CT) head showed bilateral globus pallidus hypodensities and the patient was transferred to our facility for further management. During the hospital course, the patient continued to have anterograde amnesia. MRI brain with/without contrast showed cytotoxic edema involving the bilateral hippocampi, the fornices, mammillary bodies and bilateral globus pallidus which was consistent with anoxic brain injury. A brief inpatient neuropsychological evaluation showed subtle executive dysfunction and deficits in memory retrieval and consolidation. Screening for fenantyl metabolites approximately 80 hours after use was positive for norfentanyl. Design/Methods: NA Results: NA Conclusions: The lesions seen on MRI is thought to be from stimulant-induced hypoxic-ischemic and excitotoxic injuries as the hippocampus and limbic structures appear more susceptible to such damage. This case is one among emerging cases in which acute and complete hippocampal lesions is associated with history of substance abuse, primarily opioids. Similar cases have been reported in Massachusetts, with more cases likely to be observed in the future as opioid addiction becomes endemic in the United States. Moreover, there is concern that some illicit drugs may contain additives or passed as other substances as our patient thought he was purchasing heroine. Therefore, health care providers should maintain high clinical suspicion in cases of new-onset amnesia. In addition to MRI and routine toxicology, advanced toxicology studies including fentanyl and its metabolites should be considered. Study Supported by: NA Disclosure: Dr. Vo has nothing to disclose. Dr. Duru has nothing to disclose. Dr. Pawar has nothing to disclose.