Parkinsonian syndromes with encephalopathy after heroin abuse are rare. We report a 41-year-old Caucasian woman presenting with symmetric akinetic-rigidic parkinsonism. Twenty-four hours after snorting heroin, the patient exhibited a generalized dyskinetic syndrome and impaired vision, and severe parkinsonian symptoms developed within 2 weeks. The akinetic-rigid syndrome showed good response to levodopa therapy with motor fluctuations over the course of treatment. Previous studies on heroin-induced parkinsonism have reported leukoencephalopathy with diffuse white matter hyperintensities on brain MRI corresponding to spongiform degeneration.1,2 However, gray matter lesions of the basal ganglia and, to a lesser extent, the cerebral cortex, due to heroin abuse have not been reported before in drug-induced parkinsonism (figure, A–C). We speculate that the affected brain regions reflect a noxious effect of heroin or used additives on metabolical active neurons.
Figure. The fluid-attenuated inversion recovery image (A) shows bilateral hyperintensities in the basal ganglia and the occipitopolar cortex. The latter and the globus pallidus internus are also hyperintense on the T1-weighted image (B), indicating hemorrhagic transformation. The T2-weighted image of the mesencephalon (C) shows hyperintense substantia nigra similar to the basal ganglia.
Footnotes
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Disclosure: The authors report no conflicts of interests.
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