We describe extended and repeat magnetic resonance (MR) examinations in the case of
a 16-year-old male who developed acute left-sided sensorimotor hemiplegia after a
single dose of inhaled heroin. MRI revealed symmetrical hyperintense signals in T2-weighted images and massive diffusion disorders in the diffusion weighted images
predominantly in parieto-occipital subcortical white matter and both ventral globi
pallidi with preservation of U fibers and no brain oedema. MR spectroscopy data were
compatible with combined hypoxic and mitochondrial damage resulting in axonal injury
without demyelination. Normal values and variations had been obtained from spectra
of five age-matched subjects. This is the first reported MR follow-up study of leukoencephalopathy
occurring acutely after a first inhaled dose of heroin. We postulate that toxic spongiform
leukoencephalopathy in heroin addicts may be the outcome of a complex mechanism directly
triggered by heroin and causing mitochondrial as well as hypoxic injury in specific
and limited areas of white matter.
Leukoencephalopathy - inhaled heroin - MRI - magnetic resonance spectroscopy