heroin and Brain-Ischemia

The occurrence of pallidal lesions with or without other hypoxic/ischaemic brain injuries was evaluated in 100 intravenous (i.v.) heroin addicts. The brains were collected consecutively from forensic autopsies during the period from January 1995 to June 1996. The autopsies were required by the police and performed at The Institute of Forensic Medicine, The National Hospital, Oslo. There were 21 women and 79 men, median age 32 (range 21-47) and 34 (19-60) years, respectively. Of 38 brains with abnormalities, twenty-five cases showed isolated or combined lesions of hypoxic/ischaemic origin. Pallidal lesions were found in nine brains; six lesions were old, one was subacute (a couple of weeks), and two were part of recent, generalized hypoxia/ischaemia. Six persons had old infarcts in the hippocampal formation, and one of them in combination with old pallidal infarcts. In seven brains small and old infarcts were found in watershed areas in the cerebellum. Between five and ten percent of i.v. heroin addicts might have pallidal infarcts, either as the sole lesion, or combined with other manifestations of hypoxic/ischaemic brain injury. This might give severe mental disturbances in the affected persons.

Topics: Adult; Brain; Brain Ischemia; Cause of Death; Female; Forensic Medicine; Heroin; Humans; Hypoxia; Male; Middle Aged; Narcotics; Substance Abuse, Intravenous

Stroke is an infrequent but recognized complication of heroin addiction. Two heroin addicts, aged 34 and 19 years, developed ballistic movements after intravenous heroin overdose. Patient 1 presented bilateral ballism 1 week after intravenous heroin injection. Magnetic resonance imaging (MRI) showed bilateral ischemic lesions of the globus pallidus, suggesting a generalized cerebral hypoxia during the comatose state as pathogenic mechanism. Patient 2 presented an acute left hemiballismus when consciousness was restored with naloxone. MRI demonstrated an ischemic infarct in the right striatum. An embolic mechanism of stroke was suspected in this patient, considering the normal results of blood analysis, echocardiogram and cerebral arteriograms. Ballistic movements ceased after administration of haloperidol; both patients remained without abnormal movements thereafter.

Topics: Adult; Anti-Dyskinesia Agents; Basal Ganglia; Brain Ischemia; Coma; Corpus Striatum; Drug Overdose; Globus Pallidus; Haloperidol; Heroin; Humans; Magnetic Resonance Imaging; Male; Movement Disorders; Naloxone; Narcotic Antagonists; Substance Abuse, Intravenous; Tomography, X-Ray Computed

Two young drug abusers with nontraumatic hemiplegia have been observed. Onset of symptoms occurred within minutes after intravenous administration of heroin. One case had cerebral infarction and the other cerebral hemorrhage. Hypersensitivity to heroin or an unknown adulterant may play a role.

Topics: Adolescent; Adult; Brain Ischemia; Cerebral Hemorrhage; Hemiplegia; Heroin; Heroin Dependence; Humans; Male