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

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

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