Reversible spongiform leucoencephalopathy after inhalation of heated heroin.
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.
Gacouin
Arnaud
A
Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France. arnaud.gacouin@chu-rennes.fr.
Lavoue
Sylvain
S
Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
Signouret
Thomas
T
Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
Person
Arnaud
A
Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
Dinard
Marie Dit
MD
Service de Pharmacologie, CHU Rennes, France.
Shpak
Nathalie
N
Service de médecine physique et de réadaptation, CHRU Rennes, France.
Thomas
Rémi
R
Service des maladies infectieuses et de réanimation médicale, CHU Rennes, Hôpital Pontchaillou, Rue Henri Le Guilloux-35033, Rennes, France.
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
D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D013256:Steroids; D014451:Ubiquinone