Arnaud Gacouin1, Sylvain Lavoue2, Thomas Signouret2, Arnaud Person2, Marie Dit Dinard3, Nathalie Shpak4, Rémi Thomas2. 1. Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France. arnaud.gacouin@chu-rennes.fr. 2. Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France. 3. Service de Pharmacologie, CHU Rennes, France. 4. Service de médecine physique et de réadaptation, CHRU Rennes, France.
Abstract
OBJECTIVE: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case. DESIGN: Case report. SETTING: Intensive care unit of a university teaching hospital. PATIENT: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging. MEASUREMENTS AND RESULTS: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q). CONCLUSION: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.
OBJECTIVE: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case. DESIGN: Case report. SETTING: Intensive care unit of a university teaching hospital. PATIENT: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging. MEASUREMENTS AND RESULTS: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q). CONCLUSION: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.
Authors: E C Wolters; G K van Wijngaarden; F C Stam; H Rengelink; R J Lousberg; M E Schipper; B Verbeeten Journal: Lancet Date: 1982-12-04 Impact factor: 79.321
Authors: A R Kriegstein; D C Shungu; W S Millar; B A Armitage; J C Brust; S Chillrud; J Goldman; T Lynch Journal: Neurology Date: 1999-11-10 Impact factor: 9.910