Editors' Note

Abstract

Editors' Note: In “Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia,” Ntranos et al. discussed the case of a patient with lesions in the globus pallidi, spinal cord, and cochleae in the setting of opioid overdose and respiratory failure. They concluded that the patient's neurologic syndrome was related to hypoxia. Commenting on this article, Dr. Berg asks the authors whether they considered the possibility of methylmalonic acidemia (MMA) as a potential underlying susceptibility factor because the lesions on the patient's MRI in the globus pallidi are characteristic of MMA. He suggests testing the patient's urine for MMA and blood for B12 level. Dr. Ntranos confirms that they checked the methylmalonic acid serum level, which was undetectable. Commenting on the same article, Drs. Bhatt and Adams propose that the patient's cochlear injury is related directly to opiate toxicity rather than hypoxia. Ntranos et al. stand by their hypothesis, explaining that the patient referenced by Bhatt and Adams was using multiple toxic substances for which the composition is unknown and that the presence of opiate receptors in cochlear cells does not mean that their stimulation will cause neurotoxicity. They suggest that additional research is needed to determine the direct effect of opiate use in cochlear cells. —Chafic Karam, MD, and Robert C. Griggs, MD Editors' Note: In “Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia,” Ntranos et al. discussed the case of a patient with lesions in the globus pallidi, spinal cord, and cochleae in the setting of opioid overdose and respiratory failure. They concluded that the patient's neurologic syndrome was related to hypoxia.