Home > CNS nontumor > Heroin leukoencephalopathy

CNS nontumor

Toxic and metabolic disorders

Heroin leukoencephalopathy

Author: Kymberly A. Gyure, M.D.

Last author update: 1 April 2015

Last staff update: 2 December 2024 (update in progress)

Copyright: 2002-2024, PathologyOutlines.com, Inc.

PubMed Search: Heroin [title] CNS

Table of Contents

Cite this page: Gyure K.A. Heroin leukoencephalopathy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cnsheroin.html. Accessed December 23rd, 2024.

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

Images hosted on other servers:

Axial FLAIR sequences

Increased T2 signal

Axial gadolinium enhanced T1 sequences

Case reports

36 year old man with worsening altered mental status (MedGenMed 2007;9:14)
43 year old woman with fatal case of spongiform leukoencephalopathy (J Toxicol Clin Toxicol 2003;41:887)
49 year old man with leukoencephalopathy from "chasing the dragon" (Neurology 2005;64:1755)

Treatment

Supportive care

Microscopic (histologic) description

Myelin loss / vacuolation - "spongiform encephalopathy"
Inflammatory infiltrate consisting of macrophages with associated perivascular chronic inflammation

Microscopic (histologic) images

Images hosted on other servers: