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Toxic Leukoencephalopathy from Heroin

A 20 year-old man with a history of heroin abuse developed confusion and weakness. Within a few days, he was abulic and mute. Bilateral upper motor neuron signs were present.

Show the White Matter Abnormality

Axial MRI Flair  images: note the prominent confluent areas of demyelination in in the deep white matter. Inhalation of heated heroin vapor ("chasing the dragon")  can produce progressive spongiform leukoencephalopathy.Brain MRI shows diffuse, symmetrical white matter hyperintensities.

Revised 04/23/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.