Heroin spongiform leukoencephalopathy (HSLE).
OBJECTIVE
An increasing number of heroin addicts-especially young and first-time users-prefer inhaling the drug to intravenous injection. A rare complication of inhaling heroin is the development of a spongiform leukoencephalopathy (HSLE).


METHODS
Pathological background, symptoms, imaging, and therapeutical options are discussed on the basis of an example case.


RESULTS
Pathophysiologically, a dysfunction of the oligodendrocyte mitochondria is suspected. Three distinct stages based on key symptoms are defined. Patients may remain in one stage, or pass through two, or all three stages. Magnetic resonance imaging (MRI) is necessary for diagnosis. There are few therapeutical options. Antioxidants and coenzyme Q may be beneficial. The disorder is self-limiting in the majority of cases. Complications such as hydrocephalus and diffuse cerebellar swelling may, however, require neurosurgical intervention.


CONCLUSIONS
HSLE is a rare occurrence in patients with heroin abuse. The number of undetected cases in drug-related deaths may be high. Clinical appearance may be easily mistaken for withdrawal symptoms.
Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle/Salle, Germany. mail@andreas-bach.de
A G
AG
Bach
B
B
Jordan
N A
NA
Wegener
C
C
Rusner
M
M
Kornhuber
J
J
Abbas
A
A
Surov
D000280:Administration, Inhalation; D000328:Adult; D017209:Apoptosis / Q000187:drug effects; D002531:Cerebellum / Q000187:drug effects / Q000473:pathology; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000633:toxicity*; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008928:Mitochondria / Q000187:drug effects; D009294:Narcotics / Q000008:administration & dosage / Q000633:toxicity*; D009460:Neurologic Examination / Q000187:drug effects; D020258:Neurotoxicity Syndromes / Q000175:diagnosis*; D009836:Oligodendroglia / Q000187:drug effects; D012075:Remission, Spontaneous; D014057:Tomography, X-Ray Computed
D013287:Illicit Drugs; D009294:Narcotics; D003932:Heroin