Leukoencephalopathy from “chasing the dragon”

Abstract

Abstract-Objective:To investigate whether impaired cognitive function is an early manifestation of vascular injury in the brain and therefore predicts risk of subsequent cardiovascular disease. Methods: The study population consisted of 12,096 middle-aged participants in the Atherosclerosis Risk in Communities (ARIC) Study who had no history of stroke or coronary heart disease (CHD) at the time of cognitive testing. Cognitive function was measured using the Digit-Symbol Substitution Test (DSST), the Word Fluency Test, and the Delayed Word Recall Test. Cognitive test scores were adjusted for demographic factors and then evaluated as predictors of incident cardiovascular events using Cox proportional hazards analysis. Results: Over a median follow-up period of 6.4 years, there were 516 incident cardiovascular events (292 myocardial infarctions, 50 CHD deaths, and 174 strokes), resulting in an average annual incidence rate of 0.7%. Lower adjusted scores on each cognitive test predicted a greater risk of incident cardiovascular events after controlling for established vascular risk factors (highest vs lowest quartile DSST, adjusted hazard ratio 1.56, 95% CI 1.23 to 1.97, p for linear trend by quartile Ͻ 0.001). The magnitude of the association was comparable with other commonly used predictors of vascular risk such as left ventricular hypertrophy on EKG and high-density lipoprotein cholesterol level of Ͻ35 mg/dL. Conclusion: Cognitive test scores below demographic norms predict incident cardiovascular disease in middle-aged subjects independently of established vascular risk factors.

Toxic Leukoencephalopathy after Heroin Abuse without Heroin Vapor Inhalation

“…Subsequent reports have been described across Europe [2,3,5,7,9,14,[20][21][22][24][25][26][27][28][29][30], in the USA [6,12,17], Austra- lia [23], Canada [8,11,13,16], as well as a few cases from Taiwan [10,18,19] and Hong Kong [15]. However, reports of heroin-associated leukoencephalopathy remain seldom considering the large number of heroin addicts.…”

“…Spongiform leukoencephalopathy after inhaling the heroin pyrolysate shows specific radiologic findings with symmetric lesions of high signal intensity on T2-WI in the cerebellar and occipital white matter, the posterior limb of the internal capsule, the splenium of the corpus callosum and the medial lemniscus in the brainstem [4,6,[8][9][10][11][12][13][14][15].…”

“…Inhalation of heroin vapor known as "chasing the dragon" or "chinesing" in particular leads to characteristic imaging and brain biopsy features [1][2][3][4][5][6][7][8][9]. Magnetic resonance imaging (MRI) shows symmetric white matter hyperintense signal changes in the cerebellum, the posterior cerebrum, the posterior limb of the internal capsule, the splenium of the corpus callosum, the medial lemniscus and the lateral brainstem [4,6,[8][9][10][11][12][13][14][15].…”

Mystery Case: A 48-year-old woman with bizarre behavior, neurologic symptoms, and progressive decline

“…3,4 Brain histologic changes include vacuolization, astrogliosis, decreased oligodendrocytes and axons, and an absence of myelin breakdown products. 5,6 There is no validated treatment for heroin-induced TLE and it has an estimated mortality rate of 23%. 2 Although the exact extent and method of opioid ingestion for this patient is unknown, there were multiple reports of morphine, oxycodone, and heroin use, which likely resulted in TLE in the patient.…”

Normalization of ventral tegmental area structure following acupuncture in a rat model of heroin relapse

“…This disease is characterized by the presence of spongy degeneration in the white matter[56789]. Recurrent drug use after heroin addiction may cause the occurrence of heroin spongiform leukoencephalopathy.…”