title: Reversible spongiform leucoencephalopathy after inhalation of heated heroin.
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.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Intensive care unit of a university teaching hospital.
  
  
  METHODS
  A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France. arnaud.gacouin@chu-rennes.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.affiliation: Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lavoue
authors.affiliation: Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Signouret
authors.affiliation: Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Person
authors.affiliation: Service de Pharmacologie, CHU Rennes, France.
authors.forename: Marie Dit
authors.initials: MD
authors.lastname: Dinard
authors.affiliation: Service de médecine physique et de réadaptation, CHRU Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Shpak
authors.affiliation: Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D005602:France; D006556:Heroin Dependence / Q000150:complications*; D006358:Hot Temperature; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012720:Severity of Illness Index; D013035:Spasm / Q000139:chemically induced; D013256:Steroids; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy; D016896:Treatment Outcome; D014451:Ubiquinone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D013256:Steroids; D014451:Ubiquinone