{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T22:58:12Z","timestamp":1779231492924,"version":"3.51.4"},"reference-count":29,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,9,9]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>Toxic leukoencephalopathy (TLE) is a rare pathology caused by various substances including opioids (notably heroin), immunosuppressants, chemotherapy agents, cocaine, alcohol and carbon monoxide. However, although heroin is metabolised by the body into morphine, there is a striking paucity in cases of primary oral morphine-induced TLE, especially in the adult population. We present the case of a man in his 40s admitted to hospital in respiratory depression with a Glasgow Coma Scale (GCS) score of 6 after taking an overdose of oral morphine sulphate. Following a complete recovery to baseline, he was then readmitted with an acute deterioration in his neurobehavioural condition. Initial investigations returned normal but MRI showed changes characteristic for TLE.<\/jats:p>\n               <jats:p>In cases of opioid toxicity such as ours, TLE is difficult to differentiate from delayed post-hypoxic leukoencephalopathy, due to their similar clinical presentation, disease progression and radiological manifestation. We explore how clinicians can approach this diagnostic uncertainty.<\/jats:p>","DOI":"10.1136\/bcr-2023-255291","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T22:46:02Z","timestamp":1695854762000},"page":"e255291","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Toxic leukoencephalopathy versus delayed post-hypoxic leukoencephalopathy after oral morphine sulphate overdose"],"prefix":"10.1136","volume":"16","author":[{"given":"Nicholas P","family":"Rossi","sequence":"first","affiliation":[{"name":"Acute Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, Lancashire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goutham","family":"Sathyanarayanan","sequence":"additional","affiliation":[{"name":"Acute Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, Lancashire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MdSakir","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Acute Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, Lancashire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Shakespeare","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"2025082709295591000_16.9.e255291.1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ejro.2019.06.005","article-title":"\"CHOICES\": an acronym to aid in delineating potential causes of non-metabolic, non-infectious acute toxic leukoencephalopathy","volume":"6","author":"Koksel","year":"2019","journal-title":"Eur J Radiol 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