Toxic spongiform leucoencephalopathy after inhaling heroin vapour

This is a report of clinical, CT and MRI findings in a patient with toxic spongiform leucoencephalopathy after heroin ingestion. The disease is observed in drug addicts who inhale pre-heated heroin. The clinical onset, which usually occurs some days or even longer after the last heroin consumption, is characterized by a cerebellar syndrome. The cerebellar hemispheres, the cerebellar and cerebral peduncles and the pyramidal tract may be affected. Spongiform demyelination is the morphological substrate of the lesions, which art: not contrast enhancing, hypodense on CT and hyperintense on T2-weighted MRI. The frequently pet-feet symmetry of the affection of functional systems points to a toxic and/or metabolic pathophysiological mechanism.