Heroin Spongiform Leukoencephalopathy (HSLE)

Bach, Andreas; Jordan, Berit; Wegener, N.; Rusner, Carsten; Kornhuber, Malte; Abbas, Jasmin; Surov, Alexey

doi:10.1007/s00062-012-0173-y

Cited by 20 publications

(24 citation statements)

References 28 publications

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“…Brain imaging of heroin users has revealed impaired white matter integrity, implicating OLs in the pathophysiology of opioid dependence (Bora et al, 2012; Li et al, 2016; Liu et al, 2008; Upadhyay et al, 2010; Wang et al, 2011). Heroin abuse has also been linked to leukoencephalopathies that are likely mediated by OL dysfunction (Bach et al, 2012). We performed unbiased profiling of cell-type-specific transcriptional responses to morphine and uncovered a remarkable number of alterations in gene expression that are unique to OLs.…”

Section: Discussionmentioning

confidence: 99%

Single-Cell RNA-Seq Uncovers a Robust Transcriptional Response to Morphine by Glia

et al. 2018

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SUMMARY Molecular and behavioral responses to opioids are thought to be primarily mediated by neurons, although there is accumulating evidence that other cell types play a prominent role in drug addiction. To investigate cell-type-specific opioid responses, we performed single-cell RNA sequencing (scRNA-seq) of the nucleus accumbens of mice following acute morphine treatment. Differential expression analysis uncovered unique morphine-dependent transcriptional responses by oligodendrocytes and astrocytes. We examined the expression of selected genes, including Cdkn1a and Sgk1, by FISH, confirming their induction by morphine in oligodendrocytes. Further analysis using RNA-seq of FACS-purified oligodendrocytes revealed a large cohort of morphine-regulated genes. The affected genes are enriched for roles in cellular pathways intimately linked to oligodendrocyte maturation and myelination, including the unfolded protein response. Altogether, our data illuminate the morphine-dependent transcriptional response by oligodendrocytes and offer mechanistic insights into myelination defects associated with opioid abuse.

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Section: Discussionmentioning

confidence: 99%

Single-Cell RNA-Seq Uncovers a Robust Transcriptional Response to Morphine by Glia

et al. 2018

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“…The clinical presentation of heroin-associated leukoencephalopathy, also known as "chasing the dragon" is characterized by restlessness, apathy, cerebellar speech disturbances, ataxia, hyperactive reflexes, spasticity, tremors, and choreoathetoid movements, eventually leading to hypotonia, areflexia, and possible respiratory failure. This clinical picture is associated with a mild cerebrospinal fluid pleocytosis and cerebellar signal abnormalities at magnetic resonance imaging ( Figure 5) [38]. Leukoencephalopathy from cocaine-thought to be mostly related to levamisole adulteration-has magnetic resonance imaging findings of spongiform leukoencephalopathy with white matter lesions similar to toxic-metabolic injury, primarily affecting the frontal lobe [22].…”

Section: Clinical Mimics Of Meningitis Encephalitis and Other Neuromentioning

confidence: 99%

Emerging and Underrecognized Complications of Illicit Drug Use

et al. 2015

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Illicit drug use can result in a wide range of medical complications. As the availability, synthesis, and popularity of illicit drugs evolve over time, new syndromes associated with their use may mimic infections. Some of these symptoms are anticipated drug effects, and others are complications of adulterants mixed with drugs or complications from the method of using drugs. Some illicit drugs are associated with rare infections, which are difficult to diagnosis with standard microbiological techniques. The goal of this review is to orient a wide range of clinicians-including general practitioners, emergency medicine providers, and infectious diseases specialists-to complications of illicit drug use that may be underrecognized. Improving awareness of infectious and noninfectious complications of illicit drug can expedite diagnosis and medical treatment of persons who use drugs and facilitate targeted harm reduction counseling to prevent future complications.

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“…[ 2 ] It is suspected that a dysfunction of the oligodendrocyte mitochondria and oligodendrocyte apoptosis is associated with HSLE. [ 9 ] As a consequence, HSLE is highly dependent on myelin turnover, and as a result, the slowest myelinating fibers such as the subcortical U-fibers are usually spared. [ 10 ] Opiate receptors have the highest density within the cerebellum.…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] The clinical presentation in HSLE patients varies greatly depending on their clinical stage – latent, intermediate, or vegetative dysregulation. [ 9 ] There is usually a latent period of hours, days, or months before symptoms arise. [ 16 ] HSLE patients generally present with symptoms that belong in one of the three clinical stages.…”

Section: Discussionmentioning

confidence: 99%

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Toxic leukoencephalopathy due to inhalational heroin abuse

Kashyap¹,

Majeed²,

Bowen³

et al. 2020

Ann Indian Acad Neurol

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Heroin-induced spongiform leukoencephalopathy (HSLE) is a rare condition that is strongly associated with heroin vapor inhalation which has become a popular method among heroin addicts because it poses a less immediate danger to the user and makes the drug much easier to use. We present a case of a 22-year-old male who presented with dysarthria and cerebellar symptoms starting, after 3 months of heroin inhalation. Diagnosis was confirmed to be HSLE after extensive diagnostic testing. HSLE is a rare complication of which the pathogenesis is poorly understood. Clinical history and characteristic findings on magnetic resonance imaging (diffuse, symmetric T2-hyperintensity, and diffusion restriction in frontal, parietal, occipital lobs, basal ganglia, and superior cerebellum) are diagnostic; however, care should be taken to exclude other etiologies. Treatment is primarily supportive; however, there is anecdotal evidence that coenzyme Q10 may be of benefit. The growing number of victims of the opioid crisis requires that physicians be aware of and counsel patients on the devastating neurological complications that can occur with abuse of these drugs.

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Heroin Spongiform Leukoencephalopathy (HSLE)

Abstract: HSLE is a rare occurrence in patients with heroin abuse. The number of undetected cases in drug-related deaths may be high. Clinical appearance may be easily mistaken for withdrawal symptoms.

Cited by 20 publications

References 28 publications

Single-Cell RNA-Seq Uncovers a Robust Transcriptional Response to Morphine by Glia

Single-Cell RNA-Seq Uncovers a Robust Transcriptional Response to Morphine by Glia

Emerging and Underrecognized Complications of Illicit Drug Use

Toxic leukoencephalopathy due to inhalational heroin abuse

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