Zusammenfassung
Nach dem Rauchen von illegal gehandeltem Heroin wie auch nach Kohlenmonoxid-Intoxikation kann sich eine spongiforme Leukenzephalopathie entwickeln, die klinisch zunächst durch eine überwiegend psychiatrische Symptomatik, dann durch neurologische Ausfälle auffällig wird und in einigen Fällen zum Tode führt. Nach einer Darstellung epidemiologischer und kulturhistorischer Aspekte des Rauchens von Opiaten werden kennzeichnende neuroradiologische (Hypodensität der weißen Substanz in der CCT, Signalabweichung in der MRT) und neuropathologische Befunde (intramyelinäre Vakuolisation) beschrieben. Pathophysiologisch ist ein primäres Marklagerödem wahrscheinlich. Die Besonderheiten des Stoffwechsels der Oligodendrozyten legen eine zusätzliche Dysfunktion der Mitochondrien nahe. Bisher fehlende Therapieoptionen begründen die Notwendigkeit zur Klärung der Ätiologie bei weltweit zunehmender Neigung zum Rauchen von Heroin.
Abstract
A spongiform leucoencephalopathy sometimes develops as a result of inhaling illicit heroin as well as due to carbonmonoxide-intoxication. Clinically psychiatric symptoms precede a neurological deterioration. Some patients die. After a brief description of several epidemiological and historico-cultural aspects regarding the smoking of opiates, the typical neuroradiological signs such as hypodensity of the white matter in CCT and signal alterations in MRT, and neuropathological sequelae such as intramyelinic vacuolisation are listed. Pathophysiologically an edema of the white matter in the beginning is suspected. Second, a dysfunction of the mitochondria is addressed relying on the particular metabolism of the oligodendrocytes. Since smoking of heroin is an increasingly preferred way of application in all continents and therapeutic options are still lacking, the need of further explanation of the underlying processes is stressed.
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