Neuropediatrics 2003; 34(2): 100-104
DOI: 10.1055/s-2003-39604
Short Communication

Georg Thieme Verlag Stuttgart · New York

Acute Leukoencephalopathy after Inhalation of a Single Dose of Heroin

S. Vella 1 , R. Kreis 2 , K. O. Lovblad 3 , M. Steinlin 1
  • 1Division of Child Neurology, Inselspital, Bern, Switzerland
  • 2Department of Clinical Research, University of Bern (Unit for MR Spectroscopy), Bern, Switzerland
  • 3Department of Neuroradiology, Inselspital, Bern, Switzerland
Further Information

Publication History

Received: October 7, 2002

Accepted after Revision: February 19, 2003

Publication Date:
30 May 2003 (online)

Abstract

We describe extended and repeat magnetic resonance (MR) examinations in the case of a 16-year-old male who developed acute left-sided sensorimotor hemiplegia after a single dose of inhaled heroin. MRI revealed symmetrical hyperintense signals in T2-weighted images and massive diffusion disorders in the diffusion weighted images predominantly in parieto-occipital subcortical white matter and both ventral globi pallidi with preservation of U fibers and no brain oedema. MR spectroscopy data were compatible with combined hypoxic and mitochondrial damage resulting in axonal injury without demyelination. Normal values and variations had been obtained from spectra of five age-matched subjects. This is the first reported MR follow-up study of leukoencephalopathy occurring acutely after a first inhaled dose of heroin. We postulate that toxic spongiform leukoencephalopathy in heroin addicts may be the outcome of a complex mechanism directly triggered by heroin and causing mitochondrial as well as hypoxic injury in specific and limited areas of white matter.

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M. D. Silvano Vella

Centre for Pediatric Neurology and Sleep Disorders
Lindenhofspital

Bremgartenstraße 117, Postfach

3001 Bern

Switzerland

Email: silvano.vella@gmx.net

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