Table 1.
Summary of Studies Included in Data Extraction and Literature Synthesis
| Article; Number of Cases | Agent(s) Abused (Mode of Ingestion) | Mean Age (years) | Clinical Presentation | Recovery Time and/or Mortality | Treatment |
|---|---|---|---|---|---|
| Achamallah et al. 201928; N=3 | Heroin (INH) | 25.0 | Acute encephalopathy and posturing | Case #1: No recovery at 2 months. Case #2: Partial recovery with persistent motor deficits at 8 months. Case #3: Full recovery at 5 years. |
Antioxidant therapy |
| Bianco et al. 201121; N=1 | Cocaine (NA) | 30.0 | Acute hemiplegia progressing to mutism over 6 months | Partial recovery at 2 years | Corticosteroids |
| Buxton, Sebastian, Clearsky 201129; N=13* | Heroin (INH) | 33.0 | Cerebellar dysfunction, ataxia, and dysarthria | Mortality of 48.1% (N=13) with average time to death of 54 days from onset | NA |
| Cartier, Gonzalez, Harlan 201530‘ N=3 | Cocaine (NA) | 25.0 | Severe, persistent headache and changes in level of consciousness | Cases #1 & #2: Death at 2 days Case #3: No recovery at 1 month |
Corticosteroids |
| Cheng, Chin, Chang 201931; N=19** | Heroin (IV) | 32.5 | Mixture of acute and delayed onset mental status changes, cerebellar ataxia, pyramidal signs, mutism, dysarthria, extrapyramidal signs, and incontinence | Cases #1 & #2: Full recovery For case series (N=17): Pooled data with mortality of 11.8% (N=2) at 4 weeks. Partial recovery 64.7% of cases (N=11). No recovery for 21.1% (N=4) |
Antioxidant therapy |
| Havé et al. 201222; N=1 | Heroin (Insufflation) | 46.0 | Acute behavioral disturbances with delirium, impaired comportment, involuntary movements, and apraxia | Partial recovery at 4 months, with persistent anosognosia, and deficits in attention, visual and verbal memory, and executive function | “Cognitive rehabilitation” |
| Holyoak et al. 201432; N=2 | Non-toluene solvents (INH), Opioids (NA) | 24.5 | Coma and pyramidal signs | Case #1: Partial recovery with persistent cognitive dysfunction at 8 months Case #2: No recovery |
Antioxidant therapy |
| Maschke et al. 199927; N=1 | Heroin, cocaine (NA) | 37.0 | Acute onset of altered mental status and mutism | Full recovery at 6 months | NA |
| Ryan et al. 200533; N=2 | Cocaine (NA) | 45.5 | Acute behavioral changes, confusion, aggression, and amnesia progressing to coma with posturing, pyrexia | Case #1: Death at 1 month Case #2 Death at 2 weeks |
Supportive care |
| Salgado et al. 201023; N=1 | Methadone (NA) | 65.0 | Acute onset pyramidal signs and coma | Partial recovery at 1 month | Supportive care |
| Torralba-Morón et al. 201734; N=3 | Heroin (NA) | 47.5 | Fluctuating consciousness, pyrexia, myoclonus, inattention, amnesia, and executive dysfunction | Case #1: Death at 40 days Cases #2 & 3: No recovery. |
Supportive care |
| van Esch et al. 201924; N=1 | Cocaine, Methadone (NA) | 54.0 | Psychosis progressing to catatonia with echolalia, stupor, and rigidity | Death at 3 months | Electroconvulsive therapy |
| Villella et al. 201025; N=1 | Heroin (IV) | 32.0 | Altered mental status, posturing, and right hemiparesis | Partial recovery at 2 years | NA |
| Weizer et al. 202026; N=1 | Heroin (IV) | 25.0 | Coma progressing to catatonia | No recovery at 31 days with persistent catatonia | NA |
Abbreviations: INH = inhalation; IV = intravenous; NA = not available.