He was able to retrieve all three with cues. On exam, he was alert and fully oriented and could name the previous presidents back to Reagan but had no spontaneous recall of three objects after five minutes. Other history included alcohol and tobacco use, and more recently vaping. However, after the recent overdose death of his roommate, he relapsed with what he believed was IV fentanyl in the week prior to presentation. He reported a history of an opioid use disorder for which he had been in recovery for about a year. A detailed review of systems was otherwise negative. The patient admitted that he had no recollection of the past few days. Further reporting of these cases may have implications for understanding opioid toxicity and clarifying the functional role of the hippocampus.Ī 31-year-old male with a history significant for obesity (body mass index, BMI 32.8 kg/m2), attention deficit hyperactivity disorder, as well as methamphetamine and IV drug use (opioids including fentanyl) was transferred from an outside hospital emergency department (ED) for further evaluation of unexplained global amnesia. This case is significant because of the relative absence of potentially confounding variables on presentation, including antecedent cardiorespiratory failure.
Given the totality of his presentation and the contributing variables, his medical team considered this to be a case of the newly characterized opioid-associated amnestic syndrome (OAS). CT and MRI imaging demonstrated isolated bilateral hippocampal injury. Urine fentanyl and norfentanyl were positive. General medical and neurological examinations were otherwise unrevealing. On exam, he was alert and fully oriented but had no spontaneous recall of three objects after five minutes.
The patient had been in recovery for opioid use disorder for about a year, but he relapsed on IV fentanyl in the week prior to presentation.
A 31-year-old male with a history significant for obesity, attention deficit hyperactivity disorder, methamphetamine use, and IV drug use was evaluated for unexplained global amnesia greater than 24 h.
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