Clinical and pathological characteristics of heroin spongiform leukoencephalopathy in China

Objective: To observe the clinical, image and pathological characteristics of Heroin Spongiform Leukoencephalopathy(HSLE).

Methods: Clinical, CT and MRI analysis of 28 cases, brain autopsies of 2 cases and brain biopsies of 8 cases with HE, Loyez and Congo Red staining and observation through electron microscope.

Results: The clinic, image and pathologic characteristics of HSLE: (1) the history of inhalation of heated heroin vapor; (2) among 28 cases with HSLE, recurrence of HSLE was found in 17 cases during the abstinence, in 8 cases 1-2 month after abstinence, in 2 cases 4 month after abstinence and in 1 case after inhaling large amount of heroin; (3) the majority of cases were described with the acute onset characterized by cerebellar signs; (4) pyramidal tract lesion was frequently involved, but sensory system usually remained normal; (5) CSF test was normal; (6) CT and MRI revealed extensive symmetric white matter lesions in cerebra and cerebellum; (7) spongiform vacuoles degeneration of white matter was the main morphological change.

Conclusions: Spongiform leukoencephalopathy may be considered if a patient who had a history of inhaling heated heroin vapor showed acute cerebellar signs. Spongiform vacuoles degeneration of cerebral white matter was the main pathological change.