Image of the month. Delayed and isolated basal ganglia damage after methadone intoxication

peer reviewedPreferential cerebellar localization during a severe methadone intoxication is explained by the high µ-opioid's receptors concentration in the cerebellum. If basal ganglia are affected, that may result in unfavorable progressive neurological evolution. Here, we report the case of a patient who developed neurological deterioration with akinetic mutism, pyramidal and extrapyramidal syndrome with parkinsonism and dystonia, ten days after methadone intoxication and rapid CPR. Magnetic resonance shows lenticular nuclei damage extending in caudate nuclei. Our patient is the first case reported with isolated basal ganglia’s injury in this conditions. It asks the question of physiopathological mechanisms: direct toxic effect of methadone or secondary to hypoxia. Therapeutic and neuroprotective management are also discussed