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The initial urine drug screen was negative, but a urine fentanyl screen was subsequently positive with a level of 137.3\u2009ng\/mL. MRI of the brain showed reduced diffusivity and fluid attenuated inversion recovery (FLAIR) hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum and globus pallidus. Alternative diagnoses such as infection were considered, but ultimately the history and workup led to a diagnosis of fentanyl-induced leukoencephalopathy. Three days after admission the patient became able to track, respond to voice and follow basic one-step commands. The patient does not recall the mechanism of inhalation. While there are case reports of heroin-induced leukoencephalopathy following inhaled heroin use and many routes of fentanyl, this is the first reported case of a similar phenomenon due to fentanyl inhalation.<\/jats:p>","DOI":"10.1136\/bcr-2023-258395","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T19:50:16Z","timestamp":1714420216000},"page":"e258395","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1465-8693","authenticated-orcid":false,"given":"Christopher O","family":"Eden","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duna S","family":"Alkhalaileh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Pettersson","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asad H","family":"Arastu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"key":"2025082800530422000_17.5.e258395.1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5947"},{"key":"2025082800530422000_17.5.e258395.2","doi-asserted-by":"publisher","DOI":"10.12659\/PJR.901791"},{"key":"2025082800530422000_17.5.e258395.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200108093450606"},{"key":"2025082800530422000_17.5.e258395.4","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.920310","article-title":"Case report: toxic encephalopathy caused by repeated inhalation of liquid sealant","volume":"10","author":"Wen","year":"2022","journal-title":"Front Public Health"},{"key":"2025082800530422000_17.5.e258395.5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S1353-1131(03)00035-X","article-title":"Solvent abuse-related toluene leukoencephalopathy","volume":"10","author":"Fornazzari","year":"2003","journal-title":"J Clin Forensic Med"},{"key":"2025082800530422000_17.5.e258395.6","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2012-101302"},{"key":"2025082800530422000_17.5.e258395.7","doi-asserted-by":"crossref","first-page":"120420","DOI":"10.1016\/j.jns.2022.120420","article-title":"Prognosis in substance abuse-related acute toxic leukoencephalopathy: a scoping review","volume":"442","author":"Macchi","year":"2022","journal-title":"J Neurol Sci"},{"key":"2025082800530422000_17.5.e258395.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2007.07.021"},{"key":"2025082800530422000_17.5.e258395.9","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.180.3.1800847"},{"key":"2025082800530422000_17.5.e258395.10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00062-010-0022-9","article-title":"Toxic leukoencephalopathy after heroin abuse without heroin vapor inhalation: MR imaging and clinical features in three patients","volume":"20","author":"Blasel","year":"2010","journal-title":"Clin Neuroradiol"},{"key":"2025082800530422000_17.5.e258395.11","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1001\/jamaneurol.2018.1693","article-title":"The emerging role of inhaled heroin in the opioid epidemic: a review","volume":"75","author":"Alambyan","year":"2018","journal-title":"JAMA Neurol"},{"key":"2025082800530422000_17.5.e258395.12","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-018-00666-4"},{"key":"2025082800530422000_17.5.e258395.13","unstructured":"Kim DH . 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