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Embolic stroke associated with injection of buprenorphine tablets

From the Departments of Neuroradiology (C.C.T.L., F.H.) and Neurology (S.H.L., Y.-C.W.), National Neuroscience Institute, Singapore; and Department of Diagnostic Imaging (C.C.T.L.), Yong Loo Lin School of Medicine, National University of Singapore.

Address correspondence and reprint requests to Dr Tchoyoson Lim, Department of Neuroradiology, National Neuroscience Institute, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433 tchoyoson_lim{at}nni.com.sg

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.

Abbreviations: DWI = diffusion-weighted imaging; ICA = internal carotid artery; MCA = middle cerebral artery; MRC = Medical Research Council.

This study was partly sponsored by the Singapore Radiological Society Trust Fund.

Disclosure: Author disclosures are provided at the end of the article.

Presented in part at the 45th annual meeting of the American Society of Neuroradiology, Chicago, IL, June 2007.

Received March 22, 2009. Accepted in final form June 18, 2009.

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