Heroin-Associated Spongiform Leukoencephalopathy
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The inhalation of impurities in heroin vapor is responsible for a vacuolating myelinopathy termed heroin-associated spongiform leukoencephalopathy. Findings on MRI T2-weighted sequences are nearly pathognomonic and are characterized by bilateral and symmetrical white matter hyperintensities with a predilection for the occipital and parietal lobes, splenium of the corpus callosum, and posterior limb of the internal capsule with sparing of the anterior limb. Infratentorial involvement is characterized by T2 hyperintensity in the cerebellar white matter and peduncles. Three distinct stages of illness are recognized, with ataxia and dysarthria being common initial presenting signs.A 29-year-old man presented with a three-week history of slurred speech, poor coordination, and imbalance while walking.

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