Chasing the dragon sign of toxic leukoencephalopathy

Case contributed by Dr Carlos Felipe Hurtado Arias


Found with altered state of consciousness (comatose) at home.

Patient Data

Age: 20 years
Gender: Male

Extensive symmetric low attenuation involving the cerebellum, brain stem, inner capsule, and cerebral white matter, more pronounced in the posterior half of the brain. Vascular structures and the ventricular system are normal. Calcification of the choroid plexus that lacks pathological significance.

Case Discussion

This patient is a known regular consumer of inhaled heroin. He was brought to the hospital by his relatives. Friends of the patient confirm consumption of inhaled heroin.

Toxic leukoencephalopathy described as the result of the use of inhaled heroin is known as chasing the dragon. The changes are limited to the white matter, with no cortical or ventricular involvement.

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