title: Symmetric deep cerebellar lesions after smoking heroin.
abstract: BACKGROUND
  Acute symmetric deep cerebellar lesions suggest toxic exposure.
  
  
  OBJECTIVE
  To describe a patient with striking neurologic and magnetic resonance image features.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Emergency department and office.
  
  
  METHODS
  Personal observation.
  
  
  RESULTS
  A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome.
  
  
  CONCLUSIONS
  An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.
authors: Neurology Service and Department of Radiology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. aropperm@cchcs.org
authors: Allan H
authors: AH
authors: Ropper
authors: Richard
authors: R
authors: Blair
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D002526:Cerebellar Diseases / Q000139:chemically induced* / Q000473:pathology; D003932:Heroin / Q000008:administration & dosage / Q000506:poisoning*; D006801:Humans; D008297:Male; D009294:Narcotics / Q000008:administration & dosage / Q000506:poisoning*; D019966:Substance-Related Disorders / Q000473:pathology*
chemical_list: D009294:Narcotics; D003932:Heroin