heroin and Cerebellar-Diseases

We report 4 cases of toxic leucoencephalopathy after heroin inhalation. The clinical features, which usually occur some days or even longer after the last heroin consumption, are dominated by a cerebellar syndrome. The cerebellar hemispheres are almost always affected; the cerebral hemispheres, the cerebellar peduncles and the pyramidal tract may be affected. Vacuolar demyelination is the morphological substract of the lesions, which are symmmetrical, not contrast enhancing, hypodense on CT scan and hyperintense on T2-weighted MRI. The pathophysiology is unknown and seems different from post-anoxic leucoencephalopathy. The disease is usually progressive leading sometimes to death, but some cases show slow recovery.

Topics: Administration, Inhalation; Adult; Cerebellar Ataxia; Cerebellar Diseases; Cerebellum; Demyelinating Diseases; Dysarthria; Heroin; Humans; Magnetic Resonance Imaging; Male; Pyramidal Tracts; Tomography, X-Ray Computed; Vacuoles

Toxic leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with toxic leukoencephalopathy after heroin abuse other than vapor inhalation is presented.. All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.. MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.. 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.

Topics: Administration, Inhalation; Adult; Brain Stem; Cerebellar Diseases; Diffusion Tensor Imaging; Heroin; Heroin Dependence; Humans; Leukoencephalopathies; Male

Acute symmetric deep cerebellar lesions suggest toxic exposure.. To describe a patient with striking neurologic and magnetic resonance image features.. Case report.. Emergency department and office.. Personal observation.. A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome.. An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.

Topics: Administration, Inhalation; Adult; Cerebellar Diseases; Heroin; Humans; Male; Narcotics; Substance-Related Disorders

Inhalation of pre-heated heroin ("chinese blowing") is known to cause a spongiform leukoencephalopathy with marked neurological deficits. We report on 2 patients who developed severe cerebellar symptoms several days after interruption of heroin inhalation. The MRI findings suggested myelin damage to fibre tracts in the central nervous system, which are specifically involved in this disorder. Both patients survived with severe cerebellar deficits.

Topics: Administration, Inhalation; Adult; Cerebellar Diseases; Demyelinating Diseases; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male

Topics: Abscess; Adult; Cerebellar Diseases; Female; Heroin; Humans; Nocardia Infections; Substance-Related Disorders