Spongiform leukoencephalopathy

A rare consequence of inhaling heated heroin ( chasing the dragon ) is a progressive spongiform leukoencephalopathy. The first cases of leukoencephalopathy due to inhalation of heroin pyrolysate were described in the Netherlands in 1982. The first three cases in the USA were reported in 1996 (SEDA-22, 35). 

The mechanism of heroin-induced spongiform leukoencephalopathy is not known and the disease is not reproducible in animals. Suspicions have been raised about potential contaminants, such as strychnine, caffeine, phe-nacetin, quinine, and procaine. This man started inhaling... 

In two reports from China 10 cases (nine men and one woman) of heroin-induced spongiform leukoencephalopathy have been reviewed. The first report discussed six cases with cerebellar signs and symptoms, with symmetrical lesions on neuroimaging in the white matter of the cerebellum, basal ganglia, posterior crus of the internal capsule, and the semi-oval center (25). The second report, described four cases that occurred during the abstinence period and showed improvement after 4 weeks of comprehensive treatment (26). 

Three cases of toxic and progressive spongiform leukoencephalopathy have also been reported as a result of vapor inhalation of heroin (21). There were generalized white matter abnormalities and pathology in the cerebellum, internal capsule, corpus callosum, and brain stem. 

Liao Y, Liu SX, Yi WZ, Zhou J, Tang JX, Wu B. Clinic and image features of heroin-induced spongiform leukoencephalopathy. Chin J Clin Rehab 2004 8(25) 5448-9. 

Xiao XC, Chu XF, Gu KY, Dong JZ, Su XL, Zhou CX, Suo P, Zhao HW, Chen ZW. Pathological changes in heroin-induced spongiform leukoencephalopathy and therapeutic effect of comprehensive rehabilitation a follow-up study. Chin J Clin Rehab 2004 8(7) 1339 11. 

Toxic leukoencephalopathy has been described in a 32-year-old man with heroin dependence after intravenous heroin administration [73" ]. A brain MRI scan was consistent with spongiform leukoencephalopathy. These findings reversed over 2 years. 

Nervous system Heroin-associated spongiform leukoencephalopathy has been described in a 36-year-old heroin abuser who had a 3-day history of lethargy and increasing unresponsiveness [53 ]. A CT scan showed scattered small foci of hemorrhage and an MRI scan showed injury in the bilateral subcortical white matter consistent with restricted diffusion and T2 hyperintense lesions 3 months later. 

Diamorphine, progressive spongiform leukoencephalopathy, 24.40 Diclofenac, liver damage, 20.91 Diethylstilbestrol, transgenerational effects, 31.657... 

---