A Fatal Case of Spongiform Leukoencephalopathy Linked to “Chasing the Dragon”

Long, Heather; Deore, Kimberly; Hoffman, Robert S.; Nelson, Lewis S.

doi:10.1081/clt-120025358

Cited by 26 publications

(21 citation statements)

References 15 publications

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“…The first and largest outbreak of leukoencephalopathy linked to chasing the dragon was reported 1982 in the Netherlands, and included 47 cases, 11 (23%) of whom died [6]. Since 1982, sporadic cases and small case clusters (ranging from 1-4 cases) have been report ed in Taiwan [7,8], Hong Kong[9], other European countries [4,5,10-13], the United States [3,14,15] and Canada [16]. Three larger clusters have been identified in China [17-20].…”

Section: Introductionmentioning

confidence: 99%

Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

et al. 2011

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An association between leukoencephalopathy, a disease of the white matter of the brain, and smoking heroin is well recognized. This paper describes 27 cases of leukoencephalopathy identified in two cities in British Columbia, Canada 2001-2006; the largest number of geographically and temporally defined reported cases in North America.Twenty cases of leukoencephalopathy were identified in and around Vancouver with onset dates December 2001 to July 2003; seven further cases were identified in Victoria September 2005-August 2006. Twenty (74%) of all cases were male, two couples were reported and eleven cases (55%) had Asian ethnicity. One case reported smoking heroin on a single occasion and developed mild symptoms; all other cases were hospitalized. Thirteen (48%) cases died; all had smoked heroin for a minimum of 3 years. Testing of one available heroin sample identified no substance other than common cutting agents.Although a specific etiology was not identified our study supports the theory of an intermittent exposure to a toxic agent added to the heroin or a combustion by-product. It also suggests a dose response effect rather than genetic predisposition. Collaboration with public health, health professionals, law enforcement and persons who use illegal drugs, will facilitate the early identification of cases to enable timely and complete follow-up including obtaining samples. Testing of implicated heroin samples may allow identification of the contaminant and therefore prevent further cases. It is therefore important to ensure key stakeholders are aware of our findings.

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Section: Introductionmentioning

confidence: 99%

Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

et al. 2011

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“…Antioxidant agents including coenzyme Q, vitamin C, and vitamin E have been suggested to provide a varying degree of benefit in patients with toxic leukoencephalopathy knowing their safe profile adverse effect [ 4 , 15 - 18 ]. In our first case, antioxidant treatment did not improve symptoms, whereas in our second case, it resulted in remarkable improvement.…”

Section: Discussionmentioning

confidence: 99%

Mimicking a Psychiatric Disorder: Heroin-Induced Leukoencephalopathy

Al-Chalabi

Lateef

Gharaibeh

et al. 2020

Cureus

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Toxic leukoencephalopathy is a rare cause of encephalopathy. We describe two cases of toxic leukoencephalopathy associated with opiate abuse where they were misdiagnosed and admitted to the psychiatric ward. In our case series, both patients presented with behavioral changes, restlessness, pressured speech, and cognitive impairment for which they were initially labeled as psychiatric patients and were treated as such. However, after an extensive workup to elucidate the etiology of alteration in mental status, toxic leukoencephalopathy associated with heroin abuse was found to be the culprit in both cases. Toxic leukoencephalopathy is a rare condition that can be caused by inhalation of heroin. Clinically, it may present with confusion, behavioral changes, extrapyramidal symptoms, generalized motor deficit, unresponsiveness and even death. Our cases highlight the importance of recognizing the psychiatric presentation of toxic leukoencephalopathy.

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“…A specific type of encephalopathy, toxic spongiform leukoencephalopathy (HSL, heroin inducted spongiform leukoencephalopathy), is observed in users that ingest heated vapours . This disorder has a high mortality rate and has been discussed in several studies dating from the 1980s to the present . One report showed changes in brain tissues using MRI and suggested that the mechanism of toxicity for HSL is related to impaired cellular metabolism .…”

Section: Diacetylmorphine (Heroin)mentioning

confidence: 99%

Pyrolysis of drugs of abuse: a comprehensive review

Bell

Nida

2015

Drug Testing and Analysis

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This review summarizes the literature to date relating to pyrolysis and heated vapour ingestion of drugs of abuse. In this context, heating is referred to as smoking or pyrolysis, but these are generic descriptors that encompass numerous methods of vapour generation and inhalation. Depending on the amount of drug used, diluents and contaminants present, heating conditions, and the oxidative/reductive environment, many thermal decomposition products can be formed. In addition to the recognized hazard of rapid onset of pharmacological effects of the parent drug, thermal decomposition products may be pharmacologically active as well as acutely/chronically toxic. For example, several published reports have linked heroin smoking to a form of brain encephalopathy and to the development of movement disorders. Early qualitative studies focusing on the thermal decomposition of drugs have evolved into more complex investigations employing mass spectral identification, confirmation, and elucidation of formation mechanism. In most cases, thermal decomposition begins with cleavage of the weakest bond (often C-N) to generate free radicals that then form the most stable sterically favoured products. Several reports of rearrangements at higher temperatures have been identified and hint at an underlying complexity that arises from the variety of smoking methods and conditions. Given that many designer drugs such as synthetic cannabinoids are ingested primarily through smoking, this issue has taken on new importance.

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A Fatal Case of Spongiform Leukoencephalopathy Linked to “Chasing the Dragon”

Abstract: The diagnosis of heroin pyrolysate-induced spongiform leukoencephalopathy should be considered in a patient with a history of "chasing the dragon" and neurobehavioral changes, including confusion, apathy, cerebellar signs, and motor restlessness.

Cited by 26 publications

References 15 publications

Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

Mimicking a Psychiatric Disorder: Heroin-Induced Leukoencephalopathy

Pyrolysis of drugs of abuse: a comprehensive review

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