Olney's lesions, also known as NMDA receptor antagonist neurotoxicity (NAN), are a form of potential brain damage due to drugs that have been studied experimentally and have produced neuronal damage, yet are administered by doctors to humans in the settings of pharmacotherapy and of anesthesia. They are named after John Olney, who conducted a study in 1989 to investigate neurotoxicity caused by PCP and related drugs. They are important for two reasons. Firstly, NMDA receptor antagonists are physician-prescribed drugs for therapeutic treatment of human diseases such as memantine for Alzheimer's disease and amantadine for Parkinson's disease, and also occur as street drugs that are taken recreationally. Secondly in the field of anesthesiology, the dissociative anesthesia of many general anesthetics is due to NMDA receptor antagonist properties. Because the neuronal vacuolation of Olney's lesions evolves into neuronal necrosis or death of neurons, it is important to determine whether Olney's lesions occur in humans, not only in experimental animals. The essential question is whether an NMDA receptor antagonist drug is to be considered a human neurotoxin or not. The patient safety implications for pharmacotherapy and for anesthesia would each be profound, if the answer is affirmative. History In 1989, Olney et al. discovered that neuronal vacuolation and other cytotoxic changes ("lesions") occurred in brains of rats administered NMDA antagonists, including PCP, MK-801 (dizocilpine) and ketamine. Examination of neurons in the posterior cingulate and retrosplenial cortices by electron microscopy revealed apparent lytic breakdown of mitochondria in the large vacuoles which had become apparent 2 hours after administration of an NMDA antagonist. After administration of 1.0 (mg/kg subcutaneously) MK-801 to rats, these neurotoxic changes became more apparent until about 12 hours post-dose, but the morphology of most cells appeared normal by light microscope about 24 hours post-dose. With 10 (mg/kg sc) doses of MK-801, the vacuolation reaction was still visible by light microscope 48 hours post-dose. After repeated doses of the NMDA antagonists MK-801 and PCP, the vacuolation reaction appeared consistent with the reaction after a single dose, so there was no evidence of a cumulative neurotoxic effect or that the reaction proceeded to an irreversible stage with repeated doses. The lowest doses of ketamine and tiletamine that produced neurotoxic changes visible by light microscope 4 hours post dose were 40 (mg/kg sc) and 10 (mg/kg sc), respectively. The potency of the drugs in producing these neurotoxic changes corresponded with their potency as NMDA