Toxic leucoencephalopathy after ‘chasing the dragon’

Singh, Rajinder; Saini, Monica

doi:10.11622/smedj.2015094

Cited by 19 publications

(19 citation statements)

References 11 publications

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“…Numerous reports and anecdotal descriptions of the direct neurotoxic effects of opiates are present in the medical literature (18, 21, 22). These effects are well documented in adults.…”

Section: Discussionmentioning

confidence: 99%

Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children

et al. 2017

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We present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital craniectomy, and partial cerebellectomy. Together with several other reports, these cases suggest the existence of an uncommon yet severe syndrome of acute opioid-induced malignant cerebellar edema. We hypothesize that the condition results from a combination of primary opioid receptor-mediated changes in neuronal metabolism that are exacerbated by secondary hypoxic insult. If recognized promptly, this syndrome can be treated with emergent neurosurgical intervention with good clinical outcomes. These cases also illustrate the unintended consequences and innocent victims of the spiraling prescription opioid epidemic, which will likely increase in prevalence. Recognition of this syndrome by clinicians is thus critical.

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“…Numerous reports and anecdotal descriptions of the direct neurotoxic effects of opiates are present in the medical literature (18, 21, 22). These effects are well documented in adults.…”

Section: Discussionmentioning

confidence: 99%

Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children

et al. 2017

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“…This disease has been described following exposure to heroin,6 cocaine7 and methylenedioxymethamphetamine (or ecstasy) 8. A pertinent report of fatal toxic leukoencephalopathy following an overdose of a psychoactive designer drug, legal in the USA at the time, called 2C-E or Europa, was published by Sacks et al .…”

Section: Differential Diagnosismentioning

confidence: 99%

Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoidblack mamba

Samra¹,

Boon

Packer

et al. 2017

BMJ Case Reports

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A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid () 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid , technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.

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“…Toxic leukoencephalopathy is a broad term that refers to the damage of the white matter caused by exposure to a variety of agents, including drugs of abuse such as heroin as well as irradiation, chemotherapy, and environmental toxins [ 1 - 4 ]. The inhalation of heroin vapor, historically known as “chasing the dragon”, has been associated with toxic leukoencephalopathy in many reported cases [ 2 ]. Chasing the dragon refers to a method of heroin inhalation performed by heating up heroin on aluminum foil and inhaling its vapor [ 2 - 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The inhalation of heroin vapor, historically known as “chasing the dragon”, has been associated with toxic leukoencephalopathy in many reported cases [ 2 ]. Chasing the dragon refers to a method of heroin inhalation performed by heating up heroin on aluminum foil and inhaling its vapor [ 2 - 4 ]. The practice emerged in Southeast Asia, particularly in Shanghai in the 1920s, extending to Eastern Asia and the United States in the subsequent decades [ 3 - 5 ].…”

Section: Introductionmentioning

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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Toxic leucoencephalopathy after ‘chasing the dragon’

Cited by 19 publications

References 11 publications

Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children

Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children

Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoidblack mamba

Mimicking a Psychiatric Disorder: Heroin-Induced Leukoencephalopathy

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