Article

Serious leukoencephalopathy can be related to heroin injection or
inhalation. 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. CONCLUSION: 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.
CI - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS