title: Embolic stroke associated with injection of buprenorphine tablets.
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.
authors.affiliation: Department of Neuroradiology, National Neuroscience Institute, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433. tchoyoson_lim@nni.com.sg
authors.forename: C C Tchoyoson
authors.initials: CC
authors.lastname: Lim
authors.forename: Sze Haur
authors.initials: SH
authors.lastname: Lee
authors.forename: Yee-Choon
authors.initials: YC
authors.lastname: Wong
authors.forename: Francis
authors.initials: F
authors.lastname: Hui
mesh_terms: 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*
chemical_list: D009294:Narcotics; D002047:Buprenorphine