title: [Toxic leucoencephalopathy after use of sniffed heroin, an unrecognized form of beneficial evolution].
abstract: BACKGROUND
  Serious leukoencephalopathy can be related to heroin injection or inhalation.
  
  
  METHODS
  We report the first case of leukoencephalopathy observed three weeks after a 46-year-old man sniffed heroin. The clinical presentation included cognitive and behaviour disorders, pyramidal irritation and slight gait instability. Blood and cerebrospinal fluid analyse were normal. Brain magnetic resonance imaging showed diffuse, symmetrical supratentorial white matter lesions producing high intense signals on FLAIR and b1000-weighted sequences. Proton spectroscopy revealed an increased rate of cholin, in favour of active demyelinated lesions. Brain biopsy showed intramyelinic oedema with reactive gliosis. After two and a half years, moderate attentional fluctuations and difficulties in initiating activities persisted. Repeated MRI showed a reduction of the leukoencephalopathy.
  
  
  CONCLUSIONS
  Heroin could be a cause more common than thought of leukoencephalopathy. The clinical and radiological expression and prognosis could be related to the mode of consummation (inhalation, intravenous injection, sniffing). This parameter may modulate severity and localization of brain lesions. More systematic use of MRI for patients with psychiatric symptoms after heroin intoxications could lead to a better evaluation of heroin-related neurotoxicity and potentially improve prevention.
authors: Services de neurologie, HIA Desgenettes, 108 boulevard Pinel, Lyon cedex 03, France. havelaurence@yahoo.fr
authors: L
authors: L
authors: Havé
authors: A
authors: A
authors: Drouet
authors: J-L
authors: JL
authors: Lamboley
authors: F
authors: F
authors: Cotton
authors: G
authors: G
authors: St-Pierre
authors: L
authors: L
authors: Quesnel
authors: L
authors: L
authors: Guilloton
authors: D
authors: D
authors: Felten
mesh_terms: D000280:Administration, Inhalation; D001706:Biopsy; D001923:Brain Chemistry / Q000187:drug effects; D001929:Brain Edema / Q000473:pathology; D002794:Choline / Q000378:metabolism; D003072:Cognition Disorders / Q000139:chemically induced / Q000523:psychology; D003711:Demyelinating Diseases / Q000473:pathology; D005911:Gliosis / Q000473:pathology; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006556:Heroin Dependence / Q000150:complications / Q000473:pathology / Q000523:psychology; D006801:Humans; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000473:pathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D011379:Prognosis
chemical_list: D009294:Narcotics; D003932:Heroin; D002794:Choline