Chasing the dragon: heroin smoking related toxic leukoencephalopathy
Diagnosis almost certain
Presentation
Homeless adult with altered cognition.
Patient Data
Age: Young adult
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Prominent T2 high signal with some minor swelling is seen involving the white matter particularly of the cerebellar hemispheres as well as posterior limb of internal capsule, extending up to to the subcortical perirolandic cortex. Occipital poles are also affected.
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1 year later T2 signal abnormality is still prominant.
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A repeat MRI performed 3 years after presentation demonstrates significant loss of volume in particularly in the regions of previous high T2 signal with reduction in the degree of abnormal signal.
Case Discussion
This patient had an extensive known history of heroin smoking, known colloquially as chasing the dragon. These are characteristic features.
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