CMAJ \u2022 January 25, 2000; 162 (2)
© 2000 Canadian Medical Association or its licensors
ReviewSynthèse
Chasing the dragon - neurological toxicity associated with inhalation of heroin vapour: case report
Michael D. Hill*, Perry W. Cooper{dagger} and James R. Perry*
From the Divisions of *Neurology and {dagger}Neuroradiology, Sunnybrook and Women's College Health Sciences Centre, Sunnybrook Site, Toronto, Ont.
Case
A 33-year-old white man was admitted to a Toronto hospital after being found in an unresponsive state by his sister. He was a known drug abuser and had a history of heroin and cocaine use. It was known that he took his heroin not by injection but by inhalation of heated heroin vapours, a method known as "chasing the dragon." He had last been seen well 3 days previously and had spent the intervening period in bed for unknown reasons.
The patient was intubated at the scene by paramedics and had a Glasgow coma score of 6 upon admission. He was tachypneic (38 breaths/min) but hemodynamically stable, with blood pressure of 150/95 mm Hg, normal sinus rhythm and temperature of 38°C. Neurological examination revealed that he was comatose, unresponsive to verbal or painful stimuli. His pupils were both 4 mm in diameter and reactive, and the fundi were normal. Eye movements were conjugate but roving. Corneal reflexes were present bilaterally. The face was symmetric. The breathing pattern was fast but regular. Motor examination revealed axial myoclonus involving the neck flexors, the pectoral muscles and the abdominal musculature. The patient was diffusely hypotonic, and the limbs withdrew symmetrically on painful stimuli. Reflexes were 1+ throughout, but bilateral Babinski signs were present. General examination revealed no cardiac murmurs, a clear chest and normal abdomen. No needle marks were seen.
Head CT revealed bilateral hypoattenuated regions in the pallidum. Brain MRI demonstrated diffusely abnormal areas of increased T2 signal intensity involving the deep white matter of both cerebral hemispheres and the cerebellum (Fig. 1). Magnetic resonance angiography demonstrated normal proximal cerebral circulation. Electroencephalography demonstrated diffuse bilateral moderate-voltage theta and delta activity without epileptiform abnormalities. Carbon monoxide was undetectable in the serum. Lumbar puncture showed entirely normal cerebrospinal fluid indices. Chest radiography revealed no pulmonary disease. Creatine kinase was significantly elevated, to 32 930 U/L, with no myoglobinuria. The result of HIV serologic testing was negative. The heroin metabolites O6-monoacetylmorphine and morphine were present in the urine.1 Results of tests for cocaine metabolites and other toxic agents were negative.
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Neural activity associated with cognitive regulation in heroin users: A fMRI study.
Lee TM, Zhou WH, Luo XJ, Yuen KS, Ruan XZ, Weng XC.
Neuropsychology Laboratory, The University of Hong Kong, Hong Kong, PR China.
Previous research has found heroin addicts to be impulsive. This study employed functional magnetic resonance imaging technology to investigate the differences between heroin addicts and normal controls in neural activity associated with cognitive regulation of behavior. Twenty-one Chinese men participated in this study, 11 of whom were newly admitted heroin-addicted patients and 10 of whom were healthy volunteers. In the experimental task, the subjects were required to first identify the correct directions of arrowheads and then give the opposite answers. Behaviorally, the heroin-dependent patients took a much shorter time to complete the more demanding second part of the task but committed more errors than the normal controls. This pattern of behavior, characteristic of people who are disinhibited and who tend to be impulsive, was consistent with previous reports of impulsivity observed in people who have abused heroin. The neural activity of the patients that was associated with performing the experimental task of cognitive regulation was different to that of the normal controls in terms of the pattern of prefrontal activation, the attenuation of activity in the anterior cingulate, and the additional recruitment of the right inferior parietal region. This study is the first that seeks to understand the neural activity associated with impulsive behavior in people who abuse heroin. The pattern of imaging data obtained resembled the pattern of data observed in immature brains attempting to exercise cognitive control of behavior. Further theoretical and clinical implications of the findings are discussed.
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"Forensic Sci Int. 1999 May 31;102(1):51-9.
Related Articles, Links
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Hypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts.
Andersen SN, Skullerud K.
"Institute of Pathology, National Hospital, University of Oslo, Norway.
[email protected]
The occurrence of pallidal lesions with or without other hypoxic/ischaemic brain injuries was evaluated in 100 intravenous (i.v.) heroin addicts. The brains were collected consecutively from forensic autopsies during the period from January 1995 to June 1996. The autopsies were required by the police and performed at The Institute of Forensic Medicine, The National Hospital, Oslo. There were 21 women and 79 men, median age 32 (range 21-47) and 34 (19-60) years, respectively. Of 38 brains with abnormalities, twenty-five cases showed isolated or combined lesions of hypoxic/ischaemic origin. Pallidal lesions were found in nine brains; six lesions were old, one was subacute (a couple of weeks), and two were part of recent, generalized hypoxia/ischaemia. Six persons had old infarcts in the hippocampal formation, and one of them in combination with old pallidal infarcts. In seven brains small and old infarcts were found in watershed areas in the cerebellum. Between five and ten percent of i.v. heroin addicts might have pallidal infarcts, either as the sole lesion, or combined with other manifestations of hypoxic/ischaemic brain injury. This might give severe mental disturbances in the affected persons.
PMID: 10423852 [PubMed - indexed for MEDLINE]"
These are real life case studies of nuerotoxicity in human heroin addicts. There are many more on pub med, I can post them if you wish. I'd like to see the same on pot heads.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")