Medical professionals caution of permanent mental retardation from breathing in fentanyl, evidenced by a case reported in BMJ Case Reports where a man established harmful leukoencephalopathy after snorting the drug. (Artists principle.) Credit: SciTechDaily.comToxic leukoencephalopathy has actually been seen with heroin inhalation, but this is the initially reported fentanyl case.Inhaling the synthetic opioid fentanyl may trigger possibly irreversible brain damage (harmful leukoencephalopathy), alert doctors in the journal BMJ Case Reports, after dealing with a middle-aged male found unresponsive in his hotel space after snorting the drug.Leukoencephalopathy describes swelling and damage to the brains white matter– the network of nerve fibers that make it possible for the exchange of info and communication in between different areas of the brains grey matter.First Case Linked to FentanylToxic leukoencephalopathy is a longstanding or unexpected neurological syndrome, which has been reported after heroin inhalation, known as chasing the dragon. But this is the initially reported case related to fentanyl, state the report authors.The condition appears in different symptoms and signs, the most obvious of which are behavioral and neurological modifications, varying from moderate confusion to death.the, stupor, and coma outlook for those affected normally depends on the degree of white matter injury, describe the report authors: some people will recover completely; others will progressively get worse.Clinical Presentation and DiagnosisIn this case, the guy had no previous medical issues of any note, and had actually been unconscious for an unknown duration of time in his hotel room, where unknown crushed tablets and a white residue were discovered on a nearby table.On arrival at the hospital, he wasnt able to address questions or follow commands. He reacted to discomfort stimuli to his legs, however not his arms.A brain scan revealed inflammation and swelling of white matter along with cerebellar injury. The cerebellum is the part of the brain accountable for gait and balance. He checked negative for epilepsy.A drug screen returned negative results, but a separate urine test showed an extremely high level of fentanyl, triggering a diagnosis of toxic leukoencephalopathy caused by fentanyl inhalation.Treatment and Remarkable RecoveryEighteen days later on, he remained bedbound and still needed tube feeding. He was given a number of various drugs to treat urinary incontinence, kidney injury, cognitive impairment, believed opioid withdrawal, pain and agitation, and pneumonia.After 26 days he was released to a rehabilitation facility, and after another month returned home with the assistance of outpatient physiotherapy and occupational therapy.Less than a year after his health center admission he had completely recovered and had actually gone back to work full time.Commenting on the incident, he explains his recovery as “incredible,” including: “Early on it was looking like I would require 24-hour care after being discharged, however I focused and worked hard in my treatment session and was identified not to leave the health center only to be checked into a group center for continuous care.” Conclusion and RecommendationsExpressing gratitude to all the health care experts who not only saved his life, but enabled him to get back to the life he had before, he states: “I have remorses often about what I did to myself, my partner, and my household.” The reports authors conclude: “This case illustrates the requirement for inclusion of fentanyl in routine urine drug screens for earlier recognition and proper management.” For more on this research study, see First Documented Brain Damage From Fentanyl Inhalation.Reference: “Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy” by Christopher O Eden, Duna S Alkhalaileh, David R Pettersson, Alan J Hunter and Asad H Arastu, 1 April 2024, BMJ Case Reports CP.DOI: 10.1136/ bcr-2023-258395.