CNS nontumor
Toxic and metabolic disorders
Heroin leukoencephalopathy




Topic Completed: 1 April 2015

Revised: 31 December 2018, last major update April 2015

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Heroin [title] CNS

Page views in 2018: 170
Page views in 2019 to date: 38
Cite this page: Gyure K.A. Heroin leukoencephalopathy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cnsheroin.html. Accessed March 23rd, 2019.
Definition / general
  • Toxic leukoencephalopathy secondary to the use of inhaled heroin or "chasing the dragon"
Sites
  • White matter including cerebellar white matter
Pathophysiology
  • Heating of heroin is thought to activate a lipophilic compound that damages white matter
Clinical features
  • Stage 1: predominantly cerebellar symptoms
  • Stage 2: cerebellar and extrapyramidal symptoms
  • Stage 3: progressive spasms, akinetic mutism and death
Radiology description
  • Increased signal on T2 weighted and FLAIR MR images in white matter, including cerebellar white matter with sparing of the dentate nucleus
Radiology images

Images hosted on other servers:
Missing Image

Axial FLAIR sequences

Missing Image

Increased T2 signal

Missing Image

Axial gadolinium enhanced T1 sequences

Case reports
Treatment
  • Supportive care
Microscopic (histologic) description
  • Myelin loss / vacuolation - "spongiform encephalopathy"
  • Inflammatory infiltrate consisting of macrophages with associated perivascular chronic inflammation
Microscopic (histologic) images

Images hosted on other servers:
Missing Image

Cerebral cortical gray matter

Missing Image

Perivascular inflammation: lymphocytes and macrophagess

Missing Image

Gradual loss of myelination

Missing Image

Marked loss of axons

Missing Image

Intense macrophage infiltration

Differential diagnosis
Back to top