heroin and Demyelinating-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

Neuroimaging studies in substance use disorder have shown widespread impairments in white matter (WM) microstructure suggesting demyelination and axonal damage. However, substantially fewer studies explored the generalized vs. the acute and/or specific drug effects on WM. Our study assessed whole-brain WM integrity in three subgroups of individuals addicted to drugs, encompassing those with cocaine (CUD) or heroin (HUD) use disorder, compared to healthy controls (CTL). Diffusion MRI was acquired in 58 CTL, 28 current cocaine users/CUD+, 32 abstinent cocaine users/CUD-, and 30 individuals with HUD (urine was positive for cocaine in CUD+ and opiates used for treatment in HUD). Tract-Based Spatial Statistics allowed voxelwise analyses of diffusion metrics [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)]. Permutation statistics (p-corrected < 0.05) were used for between-group t-tests. Compared to CTL, all individuals with addiction showed widespread decreases in FA, and increases in MD, RD, and AD (19-57% of WM skeleton, p < 0.05). The HUD group showed the most impairments, followed by the CUD+, with only minor FA reductions in CUD- (<0.2% of WM skeleton, p = 0.05). Longer periods of regular use were associated with decreased FA and AD, and higher subjective craving was associated with increased MD, RD, and AD, across all individuals with drug addiction (p < 0.05). These findings demonstrate extensive WM impairments in individuals with drug addiction characterized by decreased anisotropy and increased diffusivity, thought to reflect demyelination and lower axonal packing. Extensive abnormalities in both groups with positive urine status (CUD+ and HUD), and correlations with craving, suggest greater WM impairments with more recent use. Results in CUD-, and correlations with regular use, further imply cumulative and/or persistent WM damage.

Topics: Anisotropy; Brain; Cocaine; Craving; Demyelinating Diseases; Diffusion Tensor Imaging; Heroin; Humans; White Matter

Serious leukoencephalopathy can be related to heroin injection or inhalation.. We report the first case of leukoencephalopathy observed three weeks after a 46-year-old man sniffed heroin. The clinical presentation included cognitive and behaviour disorders, pyramidal irritation and slight gait instability. Blood and cerebrospinal fluid analyse were normal. Brain magnetic resonance imaging showed diffuse, symmetrical supratentorial white matter lesions producing high intense signals on FLAIR and b1000-weighted sequences. Proton spectroscopy revealed an increased rate of cholin, in favour of active demyelinated lesions. Brain biopsy showed intramyelinic oedema with reactive gliosis. After two and a half years, moderate attentional fluctuations and difficulties in initiating activities persisted. Repeated MRI showed a reduction of the leukoencephalopathy.. Heroin could be a cause more common than thought of leukoencephalopathy. The clinical and radiological expression and prognosis could be related to the mode of consummation (inhalation, intravenous injection, sniffing). This parameter may modulate severity and localization of brain lesions. More systematic use of MRI for patients with psychiatric symptoms after heroin intoxications could lead to a better evaluation of heroin-related neurotoxicity and potentially improve prevention.

Topics: Administration, Inhalation; Biopsy; Brain Chemistry; Brain Edema; Choline; Cognition Disorders; Demyelinating Diseases; Gliosis; Heroin; Heroin Dependence; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Male; Middle Aged; Narcotics; Prognosis

Topics: Administration, Inhalation; Brain; Demyelinating Diseases; Heroin; Heroin Dependence; Humans; Hypoxia, Brain; Lactic Acid

Here we report the clinical and pathological findings in a 30-year-old drug addict in whom an intravenous injection of heroin led to reversible coma with respiratory depression and heart failure. On regaining consciousness, the patient was found to have rhabdomyolysis with renal failure requiring dialysis and peripheral neuropathy. Three weeks later his neurological condition suddenly deteriorated and delayed encephalopathy developed, leading to death 20 days later. The neuropathological study of the brain disclosed pale, spongy myelin with diffuse reactive astrogliosis and microglial proliferation, without hypoxic necrotic lesions. The cerebral and cerebellar cortices were unchanged. The absence of typical hypoxic lesions and the presence of spongiosis with massive astrocytosis distinguished this case from the previously reported cases of delayed leukoencephalopathy following severe hypoxia. An immunocytochemical study designed to exclude an underlying alteration of the metabolic oxidative pathway detected normal expression of the respiratory chain complexes IV, III and V. Despite the absence of an oxidative chain alteration in our patient, we cannot exclude the possibility that an individual predisposition played a pathogenetic role in this delayed leukoencephalopathy.

Topics: Adult; Brain Diseases; Demyelinating Diseases; Heroin; Humans; Immunohistochemistry; Injections, Intravenous; Male; Rhabdomyolysis; Substance Abuse, Intravenous

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: Adult; Brain; Cocaine; Demyelinating Diseases; Electrocardiography; Heroin; Heroin Dependence; Humans; Infarction; Male; Morphine; Myelitis; Myelitis, Transverse; Myocardial Infarction; Paralysis; Substance-Related Disorders