Chasing the wrong dragon: A new presentation of heroin-induced toxic leukoencephalopathy mimicking anoxic brain injury

Journal of the Intensive Care Society
Natalie AchamallahJeffrey Fried

Abstract

Toxic leukoencephalopathy associated with heroin inhalation has been extensively described in the literature. This syndrome is characterized by progressive motor symptoms and dysautonomia that develop over weeks to months. We present three cases of abrupt-onset inhaled heroin-associated toxic leukoencephalopathy, a previously undescribed entity. These likely represent a subset of "found down" patients with acute neurologic changes not attributable to hypoxemic encephalopathy. All three had magnetic resonance imaging findings characteristic of toxic leukoencephalopathy, which has a relatively favorable prognosis. Prolonged unresponsiveness in patients "found down" after heroin overdose is often attributed to hypoxic brain injury. Brain magnetic resonance imaging is not generally included as part of routine workup. It should, however, be considered in patients with suspected inhaled heroin use due to the relatively favorable prognosis of toxic leukoencephalopathy. This is especially relevant in the setting of the current opioid epidemic and related increase in overdose-related intensive care unit admissions. The result may have significant impact on decisions about therapeutic options or continuation of care.

References

Jan 1, 1990·Journal of Substance Abuse Treatment·T H KramerG Ottomanelli
Dec 4, 1982·Lancet·E C WoltersB Verbeeten
Feb 1, 1994·Scientific American·D C Jarlais, S R Friedman
Apr 27, 2011·American Journal of Therapeutics·Juan P CordovaRaymonde Jean
Oct 12, 2012·Clinical Neuroradiology·A G BachA Surov
May 22, 2013·The Psychiatric Clinics of North America·Laura M Tormoehlen
Apr 29, 2014·Lancet·Jonathan A EdlowEelco F M Wijdicks
Jun 25, 2015·Singapore Medical Journal·Rajinder Singh, Monica Saini
Jan 1, 2016·MMWR. Morbidity and Mortality Weekly Report·Rose A RuddR Matthew Gladden
Oct 16, 2016·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Romain LefaucheurDavid Maltête
Jun 29, 2017·Polish journal of radiology·Yogesh KumarRajiv Mangla
Aug 12, 2017·Annals of the American Thoracic Society·Jennifer P StevensMichael D Howell

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Citations

Nov 11, 2020·Progress in Neuro-psychopharmacology & Biological Psychiatry·Serenella TolomeoAlex Baldacchino
Apr 28, 2021·Magnetic Resonance Imaging Clinics of North America·Steven P Meyers
Jul 7, 2021·Addiction·Katherine Herlinger, Anne Lingford-Hughes

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Methods Mentioned

BETA
sedation
biopsy

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