Chasing the dragon: heroin smoking related toxic leukoencephalopathy
History of illicit drug use.
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High T2 signal in the cerebellar hemispheric white matter, corticospinal tracts (just below the red nuclei), extending up into the posterior limb of internal capsule and perirolandic subcortical white matter and occipital lobes. Note that the increased T2 signal in the cerebellum is shine-through.
Typical appearances of heroin smoking associated toxic leukoencephalopathy, known as Chasing the dragon, in a patient with long history of heroin smoking.