Case Reports in Clinical Medicine, 2017, 6, 227-230 http://www.scirp.org/journal/crcm ISSN Online: 2325-7083 ISSN Print: 2325-7075 DOI: 10.4236/crcm.2017.68024 Aug. 9, 2017 227 Case Reports in Clinical Medicine Heroin-Induced Toxic Leukoencephalopathy Robin van Steenhoven, Giorgos Karas, Poen Tan, Henry Weinstein Department of Neurology, OLVG, Amsterdam, The Netherlands Abstract Toxic leukoencephalopathy is an important complication of heroin abuse and has mostly been described after inhaling heroin vapor, known as “chasing the dragon syndrome” or heroin inhalation leukoencephalopathy (HIL). We present a 51 year-old male patient with toxic leukoencephalopathy following intranasal administration of heroin. Keywords Clinical Neurology, Neuroradiology, Toxicology, Opiates, Toxic Leukoencephalopathy 1. Case Presentation A 51-year-old man with a history of depression was admitted after intoxication with intranasal heroin, complicated by rhabdomyolysis and acute kidney failure. On admission, vital signs were normal and no episode of coma or prolonged hypoxia had been observed. He fully recovered and had been discharged home six days later. Four weeks later the patient was represented to the ER of this hos- pital by his family with progressive behavioral changes starting one week before presentation. The family reported progressive apathy, confusion, difficulty with walking and incontinence for urine. On presentation the patient was agitated with impaired attention and disorientation in time and place. Spontaneous speech production was reduced and he only followed simple commands. Further neurological examination demonstrated remarkable, predominantly upper limb rigidity and bradykinesia. The patient deteriorated the following day and loss of spontaneous speech and worsening of the hypertonia occurred. Magnetic resonance imaging (MRI) of the brain showed, on T2-weighted im- ages, extensive confluent, diffuse white matter hyperintensities in the frontal, parietal and temporal region of both hemispheres (Figure 1). The U-fibers, corpus callosum and cerebellum and other infratentorial structures were spared. How to cite this paper: van Steenhoven, R., Karas, G., Tan, P. and Weinstein, H. (2017) Heroin-Induced Toxic Leukoence- phalopathy. Case Reports in Clinical Medi- cine, 6, 227-230. https://doi.org/10.4236/crcm.2017.68024 Received: May 30, 2017 Accepted: August 6, 2017 Published: August 9, 2017 Copyright © 2017 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access