Heroin intoxication
General description
Heroin, also known as diacetylmorphine, is a highly addictive drug derived from morphine, which is found in opium poppies. It can be administered in various ways, including injection, inhalation, or oral intake, and produces intense euphoria, contributing to its high potential for dependence. Heroin use has resurged globally, partly due to efforts to curb prescription opioid abuse, leading to an increase in overdose-related deaths.
Acute heroin overdose from intravenous injection can cause coma, severe respiratory depression, heart failure, rhabdomyolysis leading to kidney failure, and peripheral neuropathy. After initial acute symptoms subside, some users experience progressive consciousness impairment a few days to three weeks post-overdose.
Heroin inhalation, on the other hand, can lead to specific neurological symptoms such as cerebellar and extrapyramidal signs, and in severe cases, can result in akinetic mutism or even death.
Intravanous use
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CerebrumCerebral white matterDeep white matter
In the case of heroin leukoencephalopathy due to intravanous use, MRI shows bilateral T2WI and FLAIR hyperintensity in the deep cerebral white matter, often accompanied by diffusion restriction, resembling the imaging pattern seen in Carbon monoxide poisoning.
Inhalation
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CerebrumOccipital lobeCerebral white matter
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Internal capsulePosterior limb
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Cerebral peduncleCorticospinal tract
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BrainstemPonsCorticospinal tract
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BrainstemMedullaCorticospinal tract
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BrainstemMidbrainMedial lemniscus
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CerebrumTemporal lobeCerebral white matterOptic radiation
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BrainstemMedullaNucleus solitarius
MRI shows bilateral T2WI and FLAIR hyperintensity in the cerebral white matter of the occipital lobe, cerebellar white matter, posterior limb of the internal capsule, corticospinal tract within the cerebellar peduncle and brainstem, medial lemniscus, and solitary nucleus.