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Bilateral Acute Necrosis of the Globi Pallidi and Rhabdomyolysis Due to Combined Methadone and Benzodiazepine Toxicity

Corliss, Robert F. MD*; Mandal, Rakesh MBBS, MS, MPH; Soriano, Benjamin J. MD*

The American Journal of Forensic Medicine and Pathology: March 2013 - Volume 34 - Issue 1 - p 1–4
doi: 10.1097/PAF.0b013e31823a8b1e
Case Reports

Methadone continues to be a widely used maintenance therapy for opiate dependence. However, methadone-related deaths have been reported frequently for over 4 decades now. Anoxic brain injury with pulmonary edema secondary to respiratory depression is the recognized mechanism of methadone death, although pathological intracranial findings are rarely described in methadone deaths. A selective area of brain injury has never been reported with methadone use. We present a case of a 23-year-old man who had acute necrosis of the bilateral globi pallidi in the brain and systemic rhabdomyolysis after ingesting methadone and nasally insufflating alprazolam. We also present a review of the literature on deaths following opioid use and associated brain injury.

From the *Department of Pathology and Laboratory Medicine and †Waisman Center, University of Wisconsin, Madison, WI.

Manuscript received May 11, 2011; accepted September 2, 2011.

R.F.C. and R.M. contributed equally to this study.

The authors report no conflicts of interest.

Reprints: Robert F. Corliss, MD, Department of Pathology and Laboratory Medicine, 600 Highland Ave, University of Wisconsin, Madison, WI 53792. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.