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Symmetric deep cerebellar lesions after smoking heroin
Allan H Ropper1, Richard Blair
1Neurology Service and Department of Radiology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. aropperm@cchcs.org
Background:
Acute symmetric deep cerebellar lesions suggest toxic exposure.
Objective:
To describe a patient with striking neurologic and magnetic resonance image features.
Design:
Case report.
Setting:
Emergency department and office.
Methods:
Personal observation.
Results:
A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome.
Conclusions:
An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.
