@ARTICLE{Kriegstein1999-xf,
  title    = "Leukoencephalopathy and raised brain lactate from heroin vapor
              inhalation (``chasing the dragon'')",
  author   = "Kriegstein, A R and Shungu, D C and Millar, W S and Armitage, B A
              and Brust, J C and Chillrud, S and Goldman, J and Lynch, T",
  abstract = "BACKGROUND: Inhalation of heated heroin vapor (``chasing the
              dragon''), which is gaining popularity among drug users seeking
              to avoid the risks of parenteral drug administration, can produce
              progressive spongiform leukoencephalopathy. METHODS: We studied
              the clinical phenotype and course, MRI, MRS, and brain pathology
              in the first American patients described with this syndrome.
              RESULTS: Two of the three heroin users studied inhaled heroin
              pyrolysate together daily over the course of 2 weeks. They
              developed ataxia, dysmetria, and dysarthria. Patient 1 progressed
              to an akinetic mute state with decorticate posture and subsequent
              spastic quadriparesis. Patient 2 developed a mild spastic
              quadriparesis and gait freezing. Patient 3 was asymptomatic
              following less heroin exposure. Brain MRI showed diffuse,
              symmetrical white matter hyperintensities in the cerebellum,
              posterior cerebrum, posterior limbs of the internal capsule,
              splenium of the corpus callosum, medial lemniscus, and lateral
              brainstem. MRS showed elevated lactate. Brain biopsy (Patient 1)
              showed white matter spongiform degeneration with relative sparing
              of U-fibers; electron microscopy revealed intramyelinic
              vacuolation with splitting of intraperiod lines. Progressive
              deterioration occurred in Patients 1 and 2 over 4 weeks. Both
              were treated with antioxidants including oral coenzyme Q, and
              clinical improvement occurred. Patient 1 recovered nearly
              completely over 24 months. Patient 2 improved, but developed a
              delayed-onset cerebellar hand tremor. Both still have white
              matter abnormalities on MRI and MRS. CONCLUSIONS: Elevated
              lactate in white matter and the possible response to antioxidants
              suggests mitochondrial dysfunction in progressive spongiform
              leukoencephalopathy following inhalation of heated heroin vapor.",
  journal  = "Neurology",
  volume   =  53,
  number   =  8,
  pages    = "1765--1773",
  month    =  nov,
  year     =  1999,
  address  = "United States",
  language = "en"
}

{"_id":"rA5krvF69CsDfaLyL","bibbaseid":"kriegstein-shungu-millar-armitage-brust-chillrud-goldman-lynch-leukoencephalopathyandraisedbrainlactatefromheroinvaporinhalationchasingthedragon-1999","author_short":["Kriegstein, A R","Shungu, D C","Millar, W S","Armitage, B A","Brust, J C","Chillrud, S","Goldman, J","Lynch, T"],"bibdata":{"bibtype":"article","type":"article","title":"Leukoencephalopathy and raised brain lactate from heroin vapor inhalation (``chasing the dragon'')","author":[{"propositions":[],"lastnames":["Kriegstein"],"firstnames":["A","R"],"suffixes":[]},{"propositions":[],"lastnames":["Shungu"],"firstnames":["D","C"],"suffixes":[]},{"propositions":[],"lastnames":["Millar"],"firstnames":["W","S"],"suffixes":[]},{"propositions":[],"lastnames":["Armitage"],"firstnames":["B","A"],"suffixes":[]},{"propositions":[],"lastnames":["Brust"],"firstnames":["J","C"],"suffixes":[]},{"propositions":[],"lastnames":["Chillrud"],"firstnames":["S"],"suffixes":[]},{"propositions":[],"lastnames":["Goldman"],"firstnames":["J"],"suffixes":[]},{"propositions":[],"lastnames":["Lynch"],"firstnames":["T"],"suffixes":[]}],"abstract":"BACKGROUND: Inhalation of heated heroin vapor (``chasing the dragon''), which is gaining popularity among drug users seeking to avoid the risks of parenteral drug administration, can produce progressive spongiform leukoencephalopathy. METHODS: We studied the clinical phenotype and course, MRI, MRS, and brain pathology in the first American patients described with this syndrome. RESULTS: Two of the three heroin users studied inhaled heroin pyrolysate together daily over the course of 2 weeks. They developed ataxia, dysmetria, and dysarthria. Patient 1 progressed to an akinetic mute state with decorticate posture and subsequent spastic quadriparesis. Patient 2 developed a mild spastic quadriparesis and gait freezing. Patient 3 was asymptomatic following less heroin exposure. Brain MRI showed diffuse, symmetrical white matter hyperintensities in the cerebellum, posterior cerebrum, posterior limbs of the internal capsule, splenium of the corpus callosum, medial lemniscus, and lateral brainstem. MRS showed elevated lactate. Brain biopsy (Patient 1) showed white matter spongiform degeneration with relative sparing of U-fibers; electron microscopy revealed intramyelinic vacuolation with splitting of intraperiod lines. Progressive deterioration occurred in Patients 1 and 2 over 4 weeks. Both were treated with antioxidants including oral coenzyme Q, and clinical improvement occurred. Patient 1 recovered nearly completely over 24 months. Patient 2 improved, but developed a delayed-onset cerebellar hand tremor. Both still have white matter abnormalities on MRI and MRS. CONCLUSIONS: Elevated lactate in white matter and the possible response to antioxidants suggests mitochondrial dysfunction in progressive spongiform leukoencephalopathy following inhalation of heated heroin vapor.","journal":"Neurology","volume":"53","number":"8","pages":"1765–1773","month":"November","year":"1999","address":"United States","language":"en","bibtex":"@ARTICLE{Kriegstein1999-xf,\n title = \"Leukoencephalopathy and raised brain lactate from heroin vapor\n inhalation (``chasing the dragon'')\",\n author = \"Kriegstein, A R and Shungu, D C and Millar, W S and Armitage, B A\n and Brust, J C and Chillrud, S and Goldman, J and Lynch, T\",\n abstract = \"BACKGROUND: Inhalation of heated heroin vapor (``chasing the\n dragon''), which is gaining popularity among drug users seeking\n to avoid the risks of parenteral drug administration, can produce\n progressive spongiform leukoencephalopathy. METHODS: We studied\n the clinical phenotype and course, MRI, MRS, and brain pathology\n in the first American patients described with this syndrome.\n RESULTS: Two of the three heroin users studied inhaled heroin\n pyrolysate together daily over the course of 2 weeks. They\n developed ataxia, dysmetria, and dysarthria. Patient 1 progressed\n to an akinetic mute state with decorticate posture and subsequent\n spastic quadriparesis. Patient 2 developed a mild spastic\n quadriparesis and gait freezing. Patient 3 was asymptomatic\n following less heroin exposure. Brain MRI showed diffuse,\n symmetrical white matter hyperintensities in the cerebellum,\n posterior cerebrum, posterior limbs of the internal capsule,\n splenium of the corpus callosum, medial lemniscus, and lateral\n brainstem. MRS showed elevated lactate. Brain biopsy (Patient 1)\n showed white matter spongiform degeneration with relative sparing\n of U-fibers; electron microscopy revealed intramyelinic\n vacuolation with splitting of intraperiod lines. Progressive\n deterioration occurred in Patients 1 and 2 over 4 weeks. Both\n were treated with antioxidants including oral coenzyme Q, and\n clinical improvement occurred. Patient 1 recovered nearly\n completely over 24 months. Patient 2 improved, but developed a\n delayed-onset cerebellar hand tremor. Both still have white\n matter abnormalities on MRI and MRS. CONCLUSIONS: Elevated\n lactate in white matter and the possible response to antioxidants\n suggests mitochondrial dysfunction in progressive spongiform\n leukoencephalopathy following inhalation of heated heroin vapor.\",\n journal = \"Neurology\",\n volume = 53,\n number = 8,\n pages = \"1765--1773\",\n month = nov,\n year = 1999,\n address = \"United States\",\n language = \"en\"\n}\n\n","author_short":["Kriegstein, A R","Shungu, D C","Millar, W S","Armitage, B A","Brust, J C","Chillrud, S","Goldman, J","Lynch, T"],"key":"Kriegstein1999-xf","id":"Kriegstein1999-xf","bibbaseid":"kriegstein-shungu-millar-armitage-brust-chillrud-goldman-lynch-leukoencephalopathyandraisedbrainlactatefromheroinvaporinhalationchasingthedragon-1999","role":"author","urls":{},"metadata":{"authorlinks":{}}},"bibtype":"article","biburl":"https://bibbase.org/f/EJMp3HRuxirjxpcXh/references.bib","dataSources":["sAFYeB74DpbdXM9NN","4zx9n2tbeLTix3Wxr","k3cdWrThyTh5o59Rm","hq9pebjzmsTuyxGGx","h8Atv2SAy4PmShg5j"],"keywords":[],"search_terms":["leukoencephalopathy","raised","brain","lactate","heroin","vapor","inhalation","chasing","dragon","kriegstein","shungu","millar","armitage","brust","chillrud","goldman","lynch"],"title":"Leukoencephalopathy and raised brain lactate from heroin vapor inhalation (``chasing the dragon'')","year":1999}