“Chasing the Dragon”: A Fatal Case Report of Toxic Leukoencephalopathy Due to Inhaled Heroin

Source:

Ochoa-Orozco, S. A., Gutiérrez-Segura, J. C., Coral-Leiton, A. M., Trejos-Orozco, E. A., Gutiérrez-Sanjuán, Ó. I., & Carvajal-Guevara, J. D. (2019). “Chasing the Dragon”: A Fatal Case Report of Toxic Leucoencéphalopathie Due to Inhaled Heroin. Revista Colombiana de Psiquiatría.

Abstract

Background

Leukoencephalopathy is a myelin disorder caused by multiple agents, including substance abuse.

Case

A 28-year-old man arrived at the emergency department having suffered from asthenia, dizziness, disorientation and ataxia for two months. He had a two-year history of heroin inhalation. He arrived in a normal physical condition. Brain magnetic resonance showed bilateral diffuse hypointense lesions in the white matter. At day 3 after admission, he presented neurological deterioration, stupor, haemodynamic instability, respiratory failure, and died.

Discussion

Toxic leukoencephalopathy symptoms start with inattention, memory and personality changes, and may eventually cause dementia and death. Heroin inhalation is a common practice and can lead to leukoencephalopathy.

Conclusions

Leukoencephalopathy associated with heroin inhalation is a rare entity that mainly affects young adults and has a high social impact. Its aetiology is unclear, it has no effective treatment and there is a high mortality rate. Heroin consumption is on the rise in Colombia, so TL should be considered by medical staff.