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Toxic Leukoencephalopathy after Heroin Abuse without Heroin Vapor Inhalation

MR Imaging and Clinical Features in Three Patients

Toxische Leukoenzephalopathie nach nichtinhalativem Heroinabusus. MR-Bildgebung und klinischer Verlauf bei drei Patienten

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Abstract

Background and Purpose:

Toxic leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with toxic leukoencephalopathy after heroin abuse other than vapor inhalation is presented.

Patients and Methods:

All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.

Results:

MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.

Conclusion:

Toxic leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced toxic leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.

Zusammenfassung

Hintergrund und Ziel:

Die toxische spongiforme Leukoenzephalopathie ist mit der Inhalation von Heroin assoziiert. Trotz variabler und unspezifischer klinischer Symptomatik finden sich typische Magnetresonanz-(MR-)tomographische Läsionsmuster. So haben frühere Studien symmetrische infratentorielle hyperintense Läsionen und zusätzliche Veränderungen im hinteren Schenkel der Capsula interna, im Centrum semiovale und im Balken aufgezeigt. In der vorliegenden Studie werden drei weitere Fälle mit toxischer Leukoenzephalopathie nach nichtinhalativem Heroinabusus präsentiert und diskutiert.

Patienten und Methodik:

Alle drei Patienten wurden sequentiell MR-tomographisch einschließlich diffusionsgewichteter Sequenzen untersucht und die klinischen sowie laborchemischen Befunde im Verlauf analysiert.

Ergebnisse:

MR-tomographisch zeigten alle drei Patienten ähnliche symmetrische, supratentoriell gelegene hyperintense Signalkonversionen im frontalen, parietalen, okzipitalen und temporalen Marklager. Der Kortex war komplett und die subkortikalen U-Fasern waren partiell ausgespart. Darüber hinaus waren der Hirnstamm sowie die zerebellären Marklagerstrukturen nicht betroffen.

Schlussfolgerung:

Die toxische Leukoenzephalopathie ohne Einbezug des Cerebellums und des Hirnstamms ist eine seltene Komplikation bei Heroinabusus. Das Muster der heroininduzierten toxischen Leukoenzephalopathie im MRT könnte somit nicht nur durch das Heroin selbst und mögliche Zusätze, sondern auch durch die Art der Drogenapplikation hervorgerufen werden.

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Authors and Affiliations

  1. Institute of Neuroradiology, University of Frankfurt, Frankfurt, Germany

    Stella Blasel MD, Elke Hattingen, Friedhelm Zanella & Stefan Weidauer

  2. Department of Neurology, Klinikum Weilmünster, Weilmünster, Germany

    Michael Adelmann

  3. Department of Neurology, Hanse-Klinikum, Wismar, Germany

    Michael Nichtweiß

  4. Department of Neurology, Sankt-Katharinen-Hospital, Frankfurt, Germany

    Stefan Weidauer

  5. Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2–16, 60528, Frankfurt, Germany

    Stella Blasel MD

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  1. Stella Blasel MD
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  2. Elke Hattingen
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Correspondence to Stella Blasel MD.

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Blasel, S., Hattingen, E., Adelmann, M. et al. Toxic Leukoencephalopathy after Heroin Abuse without Heroin Vapor Inhalation. Clin Neuroradiol 20, 48–53 (2010). https://doi.org/10.1007/s00062-010-0022-9

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  • DOI: https://doi.org/10.1007/s00062-010-0022-9

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