Poster Session : PS 0147 ; Neurology : Confusion after “Chasing the Dragon”: A Case of Delayed Toxic Leukoencephalopathy = Poster Session : PS 0147 ; Neurology : Confusion after “Chasing the Dragon”: A Case of Delayed Toxic Leukoencephalopathy

다국어 초록 (Multilingual Abstract)

Toxic Leukoencephalopathy refers to a spectrum of leukoencephalopathies caused by iatrogenic, drug, hypoxic or infectious insults to the white matter. “Chasing the Dragon” refers to the inhalation of heated heroin fumes. Case presentation: A 31 year old gentleman with no past medical history after loss of consciousness followed by unresponsiveness for 3 hours, after his fi rst time of having “chased the dragon”, was admitted to ICU with respiratory failure requiring mechanical ventilation, recovered and returned to normal functioning within one week. Behavior was at his baseline for 2 weeks after discharge, followed by sudden onset odd behavior. On exam he was alert, but apathetic; he was mute with inappropriate smiling and following simple commands. He had functional urinary-fecal incontinence, symmetric hyperrefl exia in lower extremities and upgoing toes. HIV, syphilis, b12 defi ciency, high sedimentation rate were ruled out. Cerebrospinal fl uid showed elevated protein level. Electroencephalogram showed diffuse slowing. Magnetic resonance imaging (MRI) showed diffuse bilateral cerebral periventricular and deep and subcortical white matter high T2/FLAIR signal intensities. At 5-weeks follow up, he was talkative and coherent, with adequate affect. Cognitive Linguistic Quick Test 8-weeks after discharge, demonstrated mild attention, moderate memory and severe executive functions impairment, normal language and moderate Clock Drawing Severity Rating. Discussion: Post-hypoxic and “Chasing the Dragon” leukoencephalopathies are among the unique causes of delayed-onset toxic leukoencephalopathies. Onset usually occurs 1-3 weeks after the insult as in this patient, who developed the akinetic-mutism form of DPHL and lacked the primarily cerebellar/ataxic syndrome typical of HL. MRI fi ndings were diffuse and lacked the predominantly posterior and cerebellar distribution of HL, supporting the diagnosis of DPHL. As in our patient, most people with DPHL will improve within 3 to 12 months, but impaired attention and executive functions usually persist.