CNS nontumor
Toxic and metabolic disorders
Heroin leukoencephalopathy

Author: Kymberly A. Gyure, M.D. (see Authors page)

Revised: 18 August 2017, last major update April 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Heroin [title] CNS

Cite this page: Gyure, K.A. Heroin leukoencephalopathy. PathologyOutlines.com website. http://pathologyoutlines.com/topic/cnsheroin.html. Accessed September 20th, 2017.
Definition / general
  • Toxic leukoencephalopathy secondary to the use of inhaled heroin or "chasing the dragon"
Sites
  • White matter including cerebellar white matter
Pathophysiology
  • Heating of heroin is thought to activate a lipophilic compound that damages white matter
Clinical features
  • Stage 1: predominantly cerebellar symptoms
  • Stage 2: cerebellar and extrapyramidal symptoms
  • Stage 3: progressive spasms, akinetic mutism and death
Radiology description
  • Increased signal on T2 weighted and FLAIR MR images in white matter, including cerebellar white matter with sparing of the dentate nucleus
Radiology images

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Axial FLAIR sequences

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Increased T2 signal

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Axial gadolinium enhanced T1 sequences

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Confluent high signal hyperintensity

Case reports
Treatment
  • Supportive care
Microscopic (histologic) description
  • Myelin loss / vacuolation - "spongiform encephalopathy"
  • Inflammatory infiltrate consisting of macrophages with associated perivascular chronic inflammation
Microscopic (histologic) images

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Cerebral cortical gray matter

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Perivascular inflammation: lymphocytes and macrophagess

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Gradual loss of myelination

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Marked loss of axons

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Intense macrophage infiltration

Differential diagnosis