Mei-Yun Cheng1,2,3, Shy-Chyi Chin4, Yen-Chung Chang3,5, Tony Wu1,2, Siew-Na Lim1,2, Hsiang-Yao Hsieh1,2, Jung-Lung Hsu2,6, Chun-Wei Chang1,2, Wei-En Johnny Tseng1,2, Han-Tao Li1,2, Hsing-I Chiang1,2, Bao-Luen Chang1,2, Meng-Han Tsai7, Long-Sun Ro8,9. 1. Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 2. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan. 4. Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan. 5. Institute of Systems Neuroscience, National Tsing Hua University, Hsinchu, Taiwan. 6. Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan. 7. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 8. Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. cgrols@adm.cgmh.org.tw. 9. College of Medicine, Chang Gung University, Taoyuan, Taiwan. cgrols@adm.cgmh.org.tw.
Abstract
OBJECTIVE: Toxic leukoencephalopathy is a rare but critical neurological disorder in heroin abusers. Our aim is to compare the clinical manifestations, brain MRIs and prognoses of heroin-induced leukoencephalopathy by different intake routes. METHODS: We present two patients with toxic leukoencephalopathy caused by intravenous (IV) injection of heroin and 48 additional cases from systematic reviews of the literature published between 1994 and 2018. RESULTS: Among the 50 heroin abusers who developed leukoencephalopathy, inhalation was the most popular route (60%), followed by IV injection (30%) and snorting (10%). Mental changes, mutism and urine/fecal incontinence were the major symptoms in patients who IV injected heroin, while cerebellar ataxia and dysarthria were more common among those who inhaled heroin. Delayed-onset encephalopathy uniquely occurred in those who IV injected heroin, whereas progressive encephalopathy was more commonly observed in those who inhaled heroin. Clinical improvement was observed in 60% of patients, the overall mortality rate was 12%, and higher mortality was observed in patients who used the inhalation route (16.7%). The hallmarks on the MRIs of those who inhaled heroin were posterior to anterior involvement of the cerebral white matter and lesions in the posterior limbs of the internal capsules, cerebellum and brainstem. In contrast, those who IV injected heroin had more frequent lesions in the subcortical U fibers and the genu of the internal capsules. CONCLUSION: These data could help physicians make an early diagnosis and predict prognosis and suggest that prompt antioxidative or symptomatic treatments might reduce the long-term consequences and mortality of heroin-induced leukoencephalopathy.
OBJECTIVE:Toxic leukoencephalopathy is a rare but critical neurological disorder in heroin abusers. Our aim is to compare the clinical manifestations, brain MRIs and prognoses of heroin-induced leukoencephalopathy by different intake routes. METHODS: We present two patients with toxic leukoencephalopathy caused by intravenous (IV) injection of heroin and 48 additional cases from systematic reviews of the literature published between 1994 and 2018. RESULTS: Among the 50 heroin abusers who developed leukoencephalopathy, inhalation was the most popular route (60%), followed by IV injection (30%) and snorting (10%). Mental changes, mutism and urine/fecal incontinence were the major symptoms in patients who IV injected heroin, while cerebellar ataxia and dysarthria were more common among those who inhaled heroin. Delayed-onset encephalopathy uniquely occurred in those who IV injected heroin, whereas progressive encephalopathy was more commonly observed in those who inhaled heroin. Clinical improvement was observed in 60% of patients, the overall mortality rate was 12%, and higher mortality was observed in patients who used the inhalation route (16.7%). The hallmarks on the MRIs of those who inhaled heroin were posterior to anterior involvement of the cerebral white matter and lesions in the posterior limbs of the internal capsules, cerebellum and brainstem. In contrast, those who IV injected heroin had more frequent lesions in the subcortical U fibers and the genu of the internal capsules. CONCLUSION: These data could help physicians make an early diagnosis and predict prognosis and suggest that prompt antioxidative or symptomatic treatments might reduce the long-term consequences and mortality of heroin-induced leukoencephalopathy.
Authors: Yasemin Koksel; Can Ozutemiz; Jeffrey Rykken; Frederick Ott; Zuzan Cayci; Mark Oswood; Alexander M McKinney Journal: Eur J Radiol Open Date: 2019-06-28