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Example of opiate-related grade 4 DWI-FLAIR ATL severity. A 26-year-old comatose man with urine toxicology positive for propoxyphene (an opioid analgesic) had diffuse and confluent DWI-ADC (A–C) and FLAIR (D) abnormalities with 67% ADC loss versus NAWM. The patient had moderate long-term neurologic sequelae, with the ATLOS at 1 month being 2 and the mRS at 3 months being 3. Follow-up MR imaging was not performed.
