Toxic Leukoencephalopathy in a Patient after Intravenous Heroin Injection Following Recovery from Septic Shock: A Case Report and Review of the Literature

Abstract

Toxic leukoencephalopathy often involves white matter tracts connecting to higher cortical functions that cause different neuropsychiatric symptoms, such as inattention, forgetfulness, dementia, coma or even death. We present a patient who had just recovered after respiratory failure and septic shock, who then developed toxic leukoencephalopathy after intravenous heroin injection. Magnetic resonance imaging (MRI) appears to be essential for making a diagnosis, because clinical history is often unreliable and manifestations are nonspecific. Treatment is mainly supportive for toxic leukoencephalopathy. Physicians and psychiatrists should take a thorough history and be alert to the complex presentations of toxic encephalopathy.