Toxic Leukoencephalopathy after Heroin Abuse without Heroin Vapor Inhalation

Abstract

Toxic leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced toxic leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.

Toxic leucoencephalopathy after ‘chasing the dragon’

“…Therefore, the absence of lesions in grey matter (cortex and basal ganglia) may differentiate heroininduced TLE from HIE. (6) In our patient, the absence of grey matter involvement on MR imaging made HIE an unlikely diagnosis.…”

“…(6) In contrast, acute myelinopathy with cytotoxic oedema is thought to underlie changes seen in HIE.…”

“…Previously, Blasel et al described MR imaging findings in three patients in which hemispheric subcortical U-fibre involvement was seen with sparing of infratentorial structures; a more recent case report from India also showed total sparing of the infratentorial compartment, although inhalation was the mode of heroin use. (6,10) Paradoxically, cerebellar lesions have been reported even in patients who injected heroin intravenously. (11) The reason for cerebellar sparing is not known.…”

The Hazards of Recreational Drug Use: A Case of Toxic Leukoencephalopathy

“…It principally affects white matter tracts, resulting in a spectrum of clinical features ranging from inattention and disorientation to dementia and death [1]. Its pathophysiology, albeit unclear, is thought to involve a hypoxic-ischemic injury to the white matter of the cerebrum which results in widespread, confluent vacuolation of the latter, known as spongiform degeneration or leukoencephalopathy [5]. Neuroradiologic abnormalities are best seen in T2-weighted MRI brain scans which typically reveal bihemispheric white matter abnormalities [4].…”

Toxic leukoencephalopathy after intravenous heroin injection: a case with clinical and radiological reversibility

“…Toxic leukoencephalopathies have been more commonly described after heroin smoking, but also after heroin injection [5][6][7], intranasal administration [7], ingestion [8], and intrauterine transmission [9].…”