![]() MRI of the head revealed changes consistent with acute and complete ischemia of both hippocampi ( Figure) in all four patients at the time of initial evaluation. The four patients reported in November 2015 had been evaluated at a single Boston-area medical center during the preceding 3 years ( 1). The apparent temporospatial clustering, relatively young age at onset (19–52 years), and associated substance use among these patients should stimulate further case identification to determine whether these observations represent an emerging syndrome related to substance use or other causes (e.g., a toxic exposure). Apart from sporadic cases ( 2– 6), this combination of clinical and imaging findings has been reported rarely. Thirteen of the 14 patients underwent routine clinical toxicology screening at the time of initial evaluation eight tested positive for opioids, two for cocaine, and two for benzodiazepines. All 14 patients (mean and median age = 35 years) had been evaluated at hospitals in eastern Massachusetts. A subsequent e-mail alert, generated by the Massachusetts Board of Registration in Medicine and sent to relevant medical specialists (including neurologists, neuroradiologists, and emergency physicians), resulted in the identification of 10 additional cases that had occurred during 2012–2016. In November 2015, a neurologist in the Boston, Massachusetts, area reported four cases of an uncommon amnestic syndrome involving acute and complete ischemia of both hippocampi, as identified by magnetic resonance imaging (MRI), to the Massachusetts Department of Public Health (MDPH) ( 1). The apparent temporospatial clustering, relatively young age at onset (19–52 years), and extensive substance use associated with this group of patients suggests broader surveillance is needed to determine whether this represents an emerging syndrome related to substance use or other causes, including introduction of a toxic substance. What are the implications for public health practice? No clear etiology exists, but at time of initial evaluation, 13 of 14 tested positive for opioids or had opioid use recorded in their medical history. A single 2013 case of complete unilateral hippocampal ischemia has been linked to heroin inhalation.Ī unique cluster of 14 cases of sudden onset amnesia with acute, complete, and bilateral ischemia of the hippocampus was identified in Massachusetts during 2012–2016. Acute, complete, and bilateral ischemia of the hippocampus is a rare cause of memory loss (associated with toxic exposure, among other etiologies) that has been reported rarely and in isolation.
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