Chasing the dragon

Heroin-induced leukoencephalopathy, also known as heroin-associated spongiform leukoencephalopathy, is a toxic leukoencephalopathy caused by the inhalation of heroin fumes, which is called "chasing the dragon".

Clinical presentation

Three stages are recognized:

Only a minority of patients progress through all three.

There may be a latent period with a subclinical evolution of white matter degeneration. Progression of the disease continues even after cessation of the toxin for up to 6 months.

Pathology

There is symmetric spongiform degeneration, specifically in the cerebral and cerebellar white matter as well as the corticospinal and solitary tracts.

Radiographic features

MRI

These are similar to other toxic leukoencephalopathies with widespread white matter hyperintensity involving both supra and infratentorial compartments. The characteristic distribution includes:

• symmetrical involvement of the posterior limb of the internal capsules extending inferiorly into the pontine corticospinal tracts, and superiorly into the perirolandic subcortical white matter
• subcortical U-fibers are also usually spared
• symmetrical butterfly wing pattern involvement of the cerebellar white matter
• sparing of adjacent grey matter structures

Typically regions demonstrate high DWI signal, which only sometimes represents true diffusion restriction.

MR spectroscopy 

May show abnormally elevated intracerebral lactate in the affected white matter as well as decreased levels of N-acetylaspartic acid (NAA) in the white matter, gray matter, and cerebellum.

History and etymology

The following passage is from the original description in the American Journal of Roentgenology by Ciaran F. Keogh :

"The term “chasing the dragon” appears to have originated in China in the 1920s and became a popular mechanism of heroin administration in the 1950s in Hong Kong because the drug was cheap but impure. A small quantity of powder is placed on aluminum foil, which is then heated underneath with a lighter or matches. The heroin liquefies into a reddish-brown glob, which moves around on the foil and emits a white vapor. The glob or “dragon” is “chased” with the lighter underneath while the vapor is sucked through a straw or pipe..."

See also

• radiological manifestations of recreational drug use

Siehe auch:

• symmetrische Hypodensitäten Kleinhirn
• high T2 subcortical perirolandic cortex
• high T2 posterior limb of internal capsule
• durch Heroin verursachte Hirnschäden
• toxische Enzephalopathie

und weiter:

• Demyelinisierende Erkrankung
• collaborative publications by radiopaedians