Heroin-inhalation-induced cerebellar leukoencephalopathy

Toxic exposure may cause symmetric, bilateral lesions to deep brain structures. Inhaled heroin has been rarely reported to cause symmetrical white matter lesions. This case presentation describes the rare phenomenon of symmetrical cerebellar leukoencephalopathy caused by heroin inhalation and shows the characteristic neuroimaging findings. A 21-year-old man presented with progressive ataxia and dysmetria. He had a history of inhaling heroin but never injecting the drug. Magnetic resonance imaging of the brain demonstrated symmetric, deep cerebellar lesions sparing the dentate nucleus. The patient underwent inpatient rehabilitation, including suboxone therapy; and his deficits improved. Inhaled heroin can cause deep cerebellar lesions. It is important to consider this toxic exposure among the differential diagnoses for a brain lesion, and the condition is best treated by discontinuation of the drug.