Cytotoxic Lesions of the Corpus Callosum in an Adult Patient with Chronic Methadone Poisoning

Background. Cytotoxic lesions of the corpus callosum are a rare clinical neurological syndrome, most often detected at the stage of searching for the cause of observed neurological disorders of unclear etiology. This is due to the variety of neurological symptoms detected in this syndrome. It is extremely rare to find a description of this syndrome in the literature. The described cases most often had an infectious, post-vaccination, drug etiology. Most of the described cases developed against the background of SARS-CoV-2 infection. However, given the high density of the receptor field of the splenium of the corpus callosum, this syndrome can occur due to other causes, including drug poisoning. Taking into account the variety of clinical manifestations of this syndrome, the high variability of etiological factors, patients with acute symptoms of central nervous system lesions of unknown etiology need differential diagnosis, including cytotoxic lesions of the corpus callosum.

Aim: to present a clinical case description of cytotoxic lesions of the corpus callosum development due to methadone poisoning.

Material and methods. A clinical case of cytotoxic lesions of the corpus callosum in an adult patient on the background of methadone poisoning and metabolic liver disorders is presented. A review of the literature was also conducted: the main clinical and instrumental characteristics of cytotoxic lesions of the corpus callosum in adults, possible pathogenetic and cytotoxic mechanisms of its development were summarized, modern approaches to the diagnosis of this syndrome were highlighted.

Results. Based on the examination of the patient with the indicated anamnesis and prolonged positional compression syndrome, cytotoxic lesions of the corpus callosum were revealed, which were most likely a consequence of hypoxia and rhabdomyolysis. Complex infusion, detoxification, symptomatic and neurometabolic therapy led to the regression of neurological deficit and complete restoration of the structure of the splenium of the corpus callosum according to magnetic resonance imaging of the brain in a control study.

Conclusion. According to magnetic resonance imaging, the formation of a neurotomographic picture of cytotoxic lesions of the corpus callosum in a patient with a history of chronic methadone intoxication may be reversible. This suggests the need for a detailed clinical and laboratory assessment of the pathogenesis of the identified changes and the timely implementation of a comprehensive infusion, detoxification, and neurometabolic therapy.

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