Diagnosis:
Clinical features plus MRI
Clinical features:
Initially: Ataxia, dysmetria, and dysarthria, gait abnormalities
Later on: akinetic mute, spastic quadraparesis,
After recover: tremor
Inhalation of vaporised heroin (heroin pyrolysate) “chasing the dragon”
Findings on Investigations:
MRI:
- Involvement of white matter (cerebellum, posterior cerebrum, posterior limbs of the internal capsule, splenium of the corpus callosum, medial lemniscus, and lateral brainstem), and basal ganglia
- T2: hyperintensity Diffuse, symmetrical in above regions
- MRS: raised lactate
Pathology:
Spongiform leukoencephalopathy (white matter spongiform degeneration) with relative sparing of U-fibers
Electron microscopy EM: intramyelinic vacuolation with splitting of intraperiod lines
Treatment:
Supportive care