Zolpidem and Possible Side Effects on Brain Circulation: A Case Report and Review of Literature

The brain is one of the most sensitive organs to hypoxia and the most vulnerable to ischemia and vascular events. Zolpidem, as a GABA-A receptor agonist, has an inhibiting effect on the central nervous system. In this study, the possible side effects of zolpidem on brain perfusion were reported in a patient with zolpidem addiction. Moreover, the correlated literature has been reviewed. The patient was a 33-year-old man who was referred with a complaint of cognitive impairment, gait disturbance, confusion, and seizure. The patient reported taking the daily dose of 270 mg of zolpidem. He developed acute dystonia, rigidity, and bradykinesia during treatment with haloperidol in the psychiatric ward. Brain MRI and EEG were requested due to the prolongation of cognitive impairment and parkinsonism symptoms. The Neurologist utilized Brain MRA to determine the source of microvascular lesions found in the brain MRI. Unexpectedly, a reduction in Anterior Cerebral Artery (ACA) perfusion was detected after a comprehensive evaluation by Brain MRA. In addition, impairment of several cognitive domains was observed in the follow-up visit. Zolpidem could reduce cerebral perfusion in various vascular territories. It seems that in patients who take zolpidem with higher than therapeutic doses, vascular complications and a decreased cerebral perfusion have occurred, resulting in more neurological complications, including cognitive disorders and vascular events. A holistic investigation of the patient with zolpidem abuse and neurological symptoms would be recommended to determine the probable vascular complication of zolpidem.