title: 'Chasing the dragon': new knowledge for an old practice.
abstract: Heroin administration by "chasing the dragon," whereby the user places freebase heroin on aluminum foil, heats it below with a flame, and inhales the pyrolysate through a straw, can be associated with the rare development of a delayed-onset spongiform leukoencephalopathy. We report the case of a 46-year-old woman with a psychiatric diagnosis of depression and heroin dependence by "chasing the dragon" admitted with features of altered mental status and later development of catatonia, abulia, and akinetic mutism. A brain magnetic resonance image evidenced bilateral symmetric high-signal lesions in the white matter of the cerebrum and cerebellum on T2-weighted images compatible with toxic leukoencephalopathy. The patient's condition resolved after a hospital stay of 2 months with supportive treatment. Acute onset of neurobehavioral changes, including confusion, apathy, and cerebellar signs in a person with exposure to heroin, should prompt one to consider toxic leukoencephalopathy as a cause of presentation.
authors.affiliation: From St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cordova
authors.forename: Sabish
authors.initials: S
authors.lastname: Balan
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Korniyenko
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Alviar
authors.forename: Alberto
authors.initials: A
authors.lastname: Paniz-Mondolfi
authors.forename: Raymonde
authors.initials: R
authors.lastname: Jean
mesh_terms: D001253:Astrocytes / Q000473:pathology; D001921:Brain / Q000473:pathology; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D005260:Female; D003932:Heroin / Q000008:administration & dosage*; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D009836:Oligodendroglia / Q000473:pathology; D017096:Prion Diseases / Q000473:pathology*
chemical_list: D009294:Narcotics; D003932:Heroin