Reversible spongiform leucoencephalopathy after inhalation of heated heroin

Intensive Care Med. 2003 Jun;29(6):1012-1015. doi: 10.1007/s00134-003-1691-5. Epub 2003 Mar 14.


Objective: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case.

Design: Case report.

Setting: Intensive care unit of a university teaching hospital.

Patient: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging.

Measurements and results: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q).

Conclusion: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Antioxidants / therapeutic use
  • Critical Care / methods
  • France
  • Heroin Dependence / complications*
  • Hot Temperature
  • Humans
  • Inhalation Exposure / adverse effects*
  • Leukoencephalitis, Acute Hemorrhagic / chemically induced*
  • Leukoencephalitis, Acute Hemorrhagic / diagnosis
  • Leukoencephalitis, Acute Hemorrhagic / therapy
  • Magnetic Resonance Imaging
  • Male
  • Prognosis
  • Recovery of Function
  • Severity of Illness Index
  • Spasm / chemically induced
  • Steroids
  • Tomography, X-Ray Computed
  • Tracheotomy
  • Treatment Outcome
  • Ubiquinone / therapeutic use


  • Anti-Inflammatory Agents
  • Antioxidants
  • Steroids
  • Ubiquinone