Reversible delayed leukoencephalopathy following intravenous heroin overdose.
We present serial neuropsychological, magnetic resonance (MR) imaging and EEG changes in a case of widespread CNS myelinopathy due to intravenous heroin overdose complicated by a period of prolonged unconsciousness. Following recovery from the acute overdose, the subject had the delayed onset of akinetic mutism with urinary incontinence. Sequential formal neuro-psychological assessments over 9 months showed evolution from severe global cerebral dysfunction to moderate disturbance of frontal lobe function. Almost complete resolution of diffuse white matter signal changes, accompanied by the development of a degree of volume loss, was evident on serial MR imaging over the same period, and generalized arrhythmic delta-range slowing on the EEG evolved int o a near normal pattern.
The Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.
M H
MH
Barnett
L A
LA
Miller
S W
SW
Reddel
L
L
Davies
D000405:Akinetic Mutism / Q000139:chemically induced / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology; D004569:Electroencephalography; D003932:Heroin / Q000506:poisoning*; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning*; D009483:Neuropsychological Tests; D020127:Recovery of Function; D014474:Unconsciousness / Q000139:chemically induced / Q000473:pathology
D009294:Narcotics; D003932:Heroin