Neuroimaging Features of Heroin Inhalation Toxicity: “Chasing the Dragon”

Abstract

Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.

Methadone-Induced Toxic Leukoencephalopathy: MR Imaging and MR Proton Spectroscopy Findings

“…[8][9][10] The imaging findings in our patient are similar, though not identical, to previously reported MR imaging and spectroscopic white matter changes observed in heroin-vapor-inhalation toxicity (a practice known as "chasing the dragon"). [2][3][4]6,7 In general, the different case reports mention similar symmetric and confluent high-signal-intensity changes in the cerebral white matter observed on T2-weighted and FLAIR images with, as also observed in our patient, sparing of the subcortical U-fibers. In our patient, there was no evidence of heroin abuse in any form or involvement of any other recreational drug.…”

“…4,11 However, in our patient, there was no such a component. Similarly, a previous study by Wolters et al 11 failed to clearly identify a neurotoxic contaminant or additive responsible for the inflicted white matter damage after heroin inhalation.…”

“…1 Most of the available literature on imaging of illicit substances deals with the neurotoxic changes induced by heroin, a morphine agonist, administered either intravenously or through (repeated) inhalation. [2][3][4][5][6][7] There are only a few reported cases of severe methadone-induced toxic leukoencephalopathy that include imaging findings. [8][9][10] The imaging findings in our patient are similar, though not identical, to previously reported MR imaging and spectroscopic white matter changes observed in heroin-vapor-inhalation toxicity (a practice known as "chasing the dragon").…”

Addictive Illegal Drugs: Structural Neuroimaging

“…[45][46][47] In heroin inhalation, the drug is heated over tinfoil and the emerging vapors are inhaled. Presumably due to activation of an as-of-yet-unknown substance, an acute leukoencephalopathy may occur with generalized brain edema (Fig 5).…”

“Chasing the Dragon”—Heroin-Associated Spongiform Leukoencephalopathy

“…The MRI findings of HASL are unique and pathognomonic [4], presenting as diffuse increased T2 signal within the white matter tracts of the cerebellum and brainstem and the deep gray matter structures. DWI/ADC changes are usually consistent with a subacute process due to progressive vacuolization of the affected white matter.…”