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01-02-2019 | Original Communication

Different routes of heroin intake cause various heroin-induced leukoencephalopathies

Authors: Mei-Yun Cheng, Shy-Chyi Chin, Yen-Chung Chang, Tony Wu, Siew-Na Lim, Hsiang-Yao Hsieh, Jung-Lung Hsu, Chun-Wei Chang, Wei-En Johnny Tseng, Han-Tao Li, Hsing-I Chiang, Bao-Luen Chang, Meng-Han Tsai, Long-Sun Ro

Published in: Journal of Neurology | Issue 2/2019

Abstract

Objective

Toxic leukoencephalopathy is a rare but critical neurological disorder in heroin abusers. Our aim is to compare the clinical manifestations, brain MRIs and prognoses of heroin-induced leukoencephalopathy by different intake routes.

Methods

We present two patients with toxic leukoencephalopathy caused by intravenous (IV) injection of heroin and 48 additional cases from systematic reviews of the literature published between 1994 and 2018.

Results

Among the 50 heroin abusers who developed leukoencephalopathy, inhalation was the most popular route (60%), followed by IV injection (30%) and snorting (10%). Mental changes, mutism and urine/fecal incontinence were the major symptoms in patients who IV injected heroin, while cerebellar ataxia and dysarthria were more common among those who inhaled heroin. Delayed-onset encephalopathy uniquely occurred in those who IV injected heroin, whereas progressive encephalopathy was more commonly observed in those who inhaled heroin. Clinical improvement was observed in 60% of patients, the overall mortality rate was 12%, and higher mortality was observed in patients who used the inhalation route (16.7%). The hallmarks on the MRIs of those who inhaled heroin were posterior to anterior involvement of the cerebral white matter and lesions in the posterior limbs of the internal capsules, cerebellum and brainstem. In contrast, those who IV injected heroin had more frequent lesions in the subcortical U fibers and the genu of the internal capsules.

Conclusion

These data could help physicians make an early diagnosis and predict prognosis and suggest that prompt antioxidative or symptomatic treatments might reduce the long-term consequences and mortality of heroin-induced leukoencephalopathy.

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Title: Different routes of heroin intake cause various heroin-induced leukoencephalopathies
Authors: Mei-Yun Cheng
Shy-Chyi Chin
Yen-Chung Chang
Tony Wu
Siew-Na Lim
Hsiang-Yao Hsieh
Jung-Lung Hsu
Chun-Wei Chang
Wei-En Johnny Tseng
Han-Tao Li
Hsing-I Chiang
Bao-Luen Chang
Meng-Han Tsai
Long-Sun Ro
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 2/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-9131-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Different routes of heroin intake cause various heroin-induced leukoencephalopathies

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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