Presentation
IV heroin use, rhabdomyolysis, headache, and new persisting confusion.
Patient Data
Bilateral symmetrical hypodensity within the Globus pallidus.
Case Discussion
The globus pallidus' high metabolic activity makes it vulnerable to any disease process that would affect oxygen or glucose delivery. The mechanisms for heroin-induced ischemia include vasospasm, vasculitis secondary to immune-mediated response, embolic events due to impurities in heroin preparation, and, more generally, through hypoxia from hypoventilation and hypotension 1-3.
Bilateral globus pallidus infarction is a rare occasion. Between 5-10% of IV heroin users develop globus pallidal infracts. Other conditions known to be associated with infarct of the basal ganglia include carbon monoxide poisoning, methanol intoxication, disulfiram toxicity, diffuse hypoxic or ischemic injury from cardiorespiratory arrest, hypovolemia due to trauma, and basilar artery occlusion 4.