Embolic stroke associated with injection of buprenorphine tablets.
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.
Lim
C C Tchoyoson
CC
Department of Neuroradiology, National Neuroscience Institute, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433. tchoyoson_lim@nni.com.sg
Lee
Sze Haur
SH
Wong
Yee-Choon
YC
Hui
Francis
F
D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis / Q000473:pathology; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects; D055030:Drug Users; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects; D020521:Stroke / Q000209:etiology* / Q000473:pathology; D013923:Thromboembolism / Q000209:etiology*
D009294:Narcotics; D002047:Buprenorphine