Ataxia after ‘Chasing the Dragon’- A Case of Heroin Induced Toxic Leukoencephalopathy

Abstract

“Chasing the Dragon” refers to inhalation of the heated vapour of the free-base form of heroin. The heroin powder is placed on tinfoil above a flame until it liquefies, vaporizes and is then inhaled by the user to experience a high. Smoking of heroin is reported to have arisen in Shanghai in the 1920’s using porcelain bowls and bamboo straws[i]. The use of tinfoil in this practice was originally reported in Hong Kong in the 1950’s and is now known as ‘Chasing the Dragon’¹. This method of heroin use has seen increasing use and is now a global phenomenon including in Vancouver’s Downtown Eastside. Heroin Induced Leukoencephalopathy (HIL) is a consequence that can occur after inhalation of heroin vapour, and may present in a variety of ways varying from changes in personality, inattention and forgetfulness, to ataxia, dementia, and coma. This condition is fatal in 25 percent of cases[ii]. The pathophysiology of HIL is thought to involve the presence of a toxin that is activated by heating that causes injury, particularly to the white matter of the brain as evidenced on T2 MRI images. Treatment strategies for this condition are few and have yet to be fully investigated. We describe the case of a 30 year old male who presented with profound ataxia and dysarthria because of HIL and showed rapid short-term and sustained improvement following Buspirone treatment after previous treatment failure with an antioxidant. Buspirone has been investigated for the management of hereditary cerebellar ataxias but has not previously been implicated as a possible treatment for other causes of ataxia like HIL.

[i] Strang J, Griffi ths P Gossop M, “Heroin smoking by ‘chasing the dragon’: origins and

history Addiction (1997) 92(6), 673-683

[ii] Wolters EC; van Wijngaarden GK; Stam FC; Rengelink H; Lousberg RJ; Schipper ME; Verbeeten B Leucoencephalopathy after inhaling "heroin" pyrolysate. Lancet. 1982 Dec 4;2(8310):1233-7