A 26-year-old man with a history of heroin inhalation presented with impaired motor, speech, and cognitive functions, reduced muscle strength, hyperactive deep tendon reflexes, and intact light-tough, vibration, and pinprick sensitivity.
T2-weighted MRI revealed symmetric hyperintensity in white matter tracts, consistent with spongiform degeneration and demyelination (figure 1).1 Involvement of these white matter tracts and posterior limb of internal capsule, with sparing of the cortex and basal ganglia, is a characteristic finding in heroin-induced leukoencephalopathy, helping to distinguish it from other causes of leukoencephalopathy. 1H MRS revealed a decreased N-acetylaspartate/creatinine (NAA/Cr) ratio and a doublet lactate peak (figure 2), indicating mitochondrial dysfunction and neurotoxicity.2 MRI may precisely reveal the distribution of white matter abnormalities in patients with heroin-induced leukoencephalopathy, and 1H MRS, although not essential for the diagnosis, can help further elucidate the condition.
Figure 1. Axial T2-weighted MR images (repetition time/echo time: 4,000/99) show symmetric hyperintensity of the affected posterior cerebral (A), pons (B), and cerebellar (C) white matter. The cortex, basal ganglia, and thalami were spared.
Figure 2. 1H MRS (repetition time/echo time: 1,500/135) reveals a decreased NAA/Cr ratio and a negative doublet of lactate.
Footnotes
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Disclosure: The authors report no conflicts of interest.
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