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Fortschr Neurol Psychiatr 2022; 90(11): 523-528
DOI: 10.1055/a-1778-3662
Case Report

Toxic Spongiform Leukoencephalopathy After Intravenous Heroin Abuse: Unusual But Important Differential Diagnosis of Acute Impairment of Consciousness

Toxische spongiforme Leukoenzephalopathie nach intravenösem Heroinabusus: ungewöhnliche, aber wichtige Differentialdiagnose einer akuten Bewusstseinsstörung
Camilla Diefenbach 
1   Sankt Katharinen Krankenhaus, Neurologie, Goethe-Universität Frankfurt am Main, Fachbereich 16 Medizin, Frankfurt am Main, Germany
,
Christine Lorenz
2   Abteilung der Radiologie, Sankt Katharinen Krankenhaus, Frankfurt am Main, Germany
,
Stefan Weidauer
1   Sankt Katharinen Krankenhaus, Neurologie, Goethe-Universität Frankfurt am Main, Fachbereich 16 Medizin, Frankfurt am Main, Germany
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Abstract

Abuse of heroin vapour inhalation known as “chasing the dragon” is associated with toxic spongiform leukoencephalopathy. However, similar clinical and imaging findings may occur also after intravenous heroin abuse. We report on a 32-year-old male suffering from extensive toxic spongiform leukoencephalopathy after intravenous heroin abuse resulting in acute impairment of consciousness and a global state of confusion. MRI disclosed broad and nearly symmetrical diffusion restriction of the supratentorial white matter indicating cytotoxic oedema. In an emergency setting, differential diagnosis of acute impairment of consciousness and broad symmetrical white matter lesions in neuroimaging should also include toxic leukoencephalopathy due to intravenous heroin application.

Zusammenfassung

Der als „Chasing the Dragon“ beschriebene Heroinmissbrauch durch Inhalation kann eine toxische spongiforme Leukoenzephalopathie verursachen. Wir berichten über einen 32-jährigen Mann, bei dem auch nach intravenösem Heroinmissbrauch eine toxische spongiforme Leukoenzephalopathie auftrat, die zu einer akuten Bewusstseinsstörung und einem globalen Verwirrungszustand führte. Kernspintomographisch zeigte sich eine ausgedehnte und nahezu symmetrische Diffusionsrestriktion der supratentoriellen weißen Substanz als Ausdruck eines zytotoxischen Ödems. In einer Notfallsituation sollte die Differentialdiagnose einer akuten Bewusstseinsstörung mit Nachweis symmetrischer zytotoxischer Läsionen der weißen Substanz im MRT auch eine toxische Leukoenzephalopathie aufgrund intravenöser Heroinverabreichung mit einschließen.

Key words

acute impairment of consciousness - chasing the dragon - toxic spongiform leukoencephalopathy - intravenous heroin abuse - MRI

Schlüsselwörter

akute Bewusstseinsstörung - chasing the dragon - toxische spongiforme - Leukoenzephalopathie - intravenöser Heroinabusus - MRT


Publication History

Received: 09 September 2021

Accepted after revision: 14 February 2022

Article published online:
18 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14,70469 Stuttgart, Germany

 

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