Reversible parkinsonism following heroin pyrolysate inhalation is associated with tetrahydrobiopterin deficiency.
A patient who inhaled heroin vapour (chasing the dragon), resulting in temporary parkinsonism, is described. A reversible deficiency of tetrahydrobiopterin, causing altered dopamine metabolism, is demonstrated as the metabolic basis of this aspect of the encephalopathy.
Heales
Simon
S
Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Crawley
Francesca
F
Rudge
Peter
P
D000328:Adult; D001708:Biopterins / Q000031:analogs & derivatives* / Q000172:deficiency*; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D001928:Brain Diseases, Metabolic / Q000209:etiology / Q000473:pathology; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D003932:Heroin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006556:Heroin Dependence / Q000150:complications*; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D020734:Parkinsonian Disorders / Q000209:etiology* / Q000503:physiopathology*
D001708:Biopterins; D006897:Hydroxyindoleacetic Acid; D003932:Heroin; C003402:sapropterin; D006719:Homovanillic Acid