Acute toxic leucoencephalopathy following protonitazene ingestion

Acute toxic leucoencephalopathy following protonitazene ingestion | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 30 May 2025 V1 Latest version Share on Acute toxic leucoencephalopathy following protonitazene ingestion Authors : Ruadhan O Laoi 0009-0003-1105-571X [email protected] , Holly Acton , Pierce Kavanagh , Isabelle Hunt , Niall Sheehy , and Cormac Kennedy Authors Info & Affiliations https://doi.org/10.22541/au.174859943.36276068/v1 304 views 147 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Distribution of illicit counterfeit alprazolam containing the highly potent synthetic opioid-receptor agonist protonitazene recently resulted in a number of severe overdoses in Ireland. We report three cases that presented to our hospital, within six weeks of one another, following ingestion of illicitly-sourced alprazolam. All cases demonstrated clinical and radiological findings consistent with acute toxic leucoencephalopathy. Case reports: A 19-year-old male ingested several tablets of counterfeit alprazolam. Magnetic resonance imaging (MRI) demonstrated mild white matter changes consistent with acute toxic leucoencephalopathy. He was extubated after 6 days and made a full neurological recovery by day 22. A 30-year-old male suffered an out-of-hospital cardiac arrest following ingestion of illictly-sourced alprazolam. MRI demonstrated extensive white matter changes in a distribution consistent with severe acute toxic leucoencephalopathy. There was no neurological recovery and he passed away 30 days following presentation. A 36-year-old male was found surrounded by empty packaging of illicitly-sourced alprazolam. He was intubated and subsequent MRI demonstrated near-identical features to that of Case 2. He made no neurological recovery by day 27 and passed away on day 45. Analysis by gas chromatography-mass spectrometry identified protonitazene in the recovered tablets of Case 1 and 2. Case 3 had no tablets available for analysis, though the empty alprazolam packaging was identical to that seen in case 1 and 2. Conclusion: These cases describe a trio of local protonitazene poisonings that were associated with the development of acute toxic leucoencephalopathy. Prognosis was poor but variable, with a correlation between radiological severity and neuroprognostication. Supplementary Material File (acute_toxic_leucoencephalopathy_following_protonitazene_ingestion_submission_bjcp.docx) Download 1.14 MB Information & Authors Information Version history V1 Version 1 30 May 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords adverse drug reactions imaging mri neuropharmacology opioids pain toxicity toxicology Authors Affiliations Ruadhan O Laoi 0009-0003-1105-571X [email protected] St James's Hospital View all articles by this author Holly Acton St James's Hospital View all articles by this author Pierce Kavanagh Trinity College Dublin View all articles by this author Isabelle Hunt Trinity College Dublin View all articles by this author Niall Sheehy St James's Hospital View all articles by this author Cormac Kennedy St James's Hospital View all articles by this author Metrics & Citations Metrics Article Usage 304 views 147 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ruadhan O Laoi, Holly Acton, Pierce Kavanagh, et al. Acute toxic leucoencephalopathy following protonitazene ingestion. Authorea . 30 May 2025. 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