BACKGROUNDPrevious studies with animal experiments, autopsy, structural magnetic resonance imaging (MRI) and task-related functional MRI (fMRI) have confirmed that brain functional connectivity in addicts has become impaired. The goal of this study was to investigate the alteration of resting-state functional connectivity of the ventral anterior cingulate cortex (vACC) in the heroin abusers' brain.

METHODSFifteen heroin abusers and fifteen matched healthy volunteers were studied using vACC as the region-of interest (ROI) seed. A 3.0 T scanner with a standard head coil was the imagining apparatus. T2*-weighted gradient-echo planar imaging (GRE-EPI) was the scanning protocol. A ROI seed based correlation analysis used a SPM5 software package as the tool for all images processing.

RESULTSThis study showed a functional connection to the insula vACC in heroin abusers. Compared with controls, heroin users showed decreased functional connectivity between the nucleus accumbens (NAc) and vACC, between the parahippocampala gyrus/amgdala (PHC/amygdala) and vACC, between the thalamus and vACC, and between the posterior cingulated cortex/precuneus (PCC/pC) and vACC.

CONCLUSIONThe altered resting-state functional connectivity to the vACC suggests the neural circuitry on which the addictive drug has an affect and reflects the dysfunction of the addictive brain.

Adult ; Female ; Gyrus Cinguli ; pathology ; physiopathology ; Heroin Dependence ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

BACKGROUNDPrevious animal and neuroimaging studies have demonstrated that brain function in heroin addicted users is impaired. However, the posterior cingulate cortex (PCC) has not received much attention. The purpose of this study was to investigate whether chronic heroin use is associated with craving-related changes in the functional connectivity of the PCC of heroin addicted users.

METHODSFourteen male adult chronic heroin users and fifteen age and gender-matched healthy subjects participated in the present study. The participants underwent a resting-state functional magnetic resonance imaging (fMRI) scan and a cue-induced craving task fMRI scan. The activated PCC was identified in the cue-induced craving task by means of a group contrast test. Functional connectivity was analyzed based on resting-state fMRI data in order to determine the correlation between brain regions. The relationship between the connectivity of specific regions and heroin dependence was investigated.

RESULTSThe activation of PCC, bilateral anterior cingulate cortex, caudate, putamen, precuneus, and thalamus was significant in the heroin group compared to the healthy group in the cue-induced craving task. The detectable functional connectivity of the heroin users was stronger between the PCC and bilateral insula, bilateral dorsal striatum, right inferior parietal lobule (IPL) and right supramarginal gyrus (P < 0.001) compared to that of the healthy subjects in the resting-state data analysis. The strength of the functional connectivity, both for the PCC-insula (r = 0.60, P < 0.05) and for PCC-striatum (r = 0.58, P < 0.05), was positively correlated with the duration of heroin use.

CONCLUSIONThe altered functional connectivity patterns in the PCC-insula and PCC-striatum areas may be regarded as biomarkers of brain damage severity in chronic heroin users.

Adult ; Female ; Gyrus Cinguli ; physiopathology ; Heroin Dependence ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. 'Chasing the dragon' is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.
Administration, Inhalation ; Brain ; pathology ; Disease Progression ; Heroin ; administration & dosage ; Heroin Dependence ; complications ; Humans ; Leukoencephalopathies ; chemically induced ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; Singapore

OBJECTIVE: To investigate ultrastructural pathological changes of Heroin-Addicts. METHODS: Heroin-Addicts' central nervous system, endocrine system, immune system and reproductive system in 4 cases are observed by using transmission electron microscope(TEM). RESULTS: The changes of central nervous system are mitochondrion swelling, crista fragmentation and disappear. Endoplasmic reticulum dilation, nervous fibres and cell organelles reduction; mitochondrion swelling, Partial crista fragmentation and endoplasmic reticulum dilation are also found in endocrine system; Lymphocytes reduction, cytoplasm ingredient reduction and dead lymphocytes increase in immune system; in reproductive system, spermatogenic cells and cell organelles are reduced in the male and follicle disappeared in the female. CONCLUSION Ultra-structural pathological changes of heroin-addicts are presented acute, chronic oxygen deficiency degeneration and necrosis.
Central Nervous System/ultrastructure* ; Endocrine System/ultrastructure* ; Female ; Genitalia/ultrastructure* ; Heroin Dependence/pathology* ; Humans ; Immune System/ultrastructure* ; Male ; Microscopy, Electron

OBJECTIVETo investigate the relationship between heroin spongiform leucoencephalopathy and respiratory chain complex I deficiency.

METHODSThe activity of respiratory chain complex I in peripheral white blood cell mitochondria was compared between 36 cases of heroin spongiform leucoencephalopathy and 36 healthy subjects using enzyme-linked immunosorbent assay (ELISA).

RESULTSThe activity of respiratory chain complex I was 5.6∓2.4 U/ml in patients with heroin spongiform leucoencephalopathy, significantly higher than that in the normal subjects (4.2∓2.1 U/ml, t=2.634, P<0.05).

CONCLUSIONIn patients with heroin spongiform leucoencephalopathy, mitochondrial dysfunction results in energy metabolism disorder to cause extensive demyelination of the cerebral white matter. Respiratory chain complex I deficiency of the mitochondria plays a significant role in the pathogenesis of heroin spongiform leucoencephalopathy.

Adult ; Canavan Disease ; etiology ; metabolism ; pathology ; Case-Control Studies ; Electron Transport ; Female ; Heroin Dependence ; complications ; metabolism ; pathology ; Humans ; Male ; Middle Aged ; Mitochondrial Diseases ; metabolism ; Young Adult

OBJECTIVETo review the magnetic resonance imaging (MRI) features and explore the histopathological basis of heroin-associated encephalopathy (HE).

METHODSThe data were collected from 34 established HE cases diagnosed with epidemiological evidence, clinical manifestations, MRI findings and laboratory examination. Histopathological sections were obtained in 10 cases. All patients were examined with T1WI, T2WI and FLAIR using 1.5T MRI scanner. Four patients died and autopsy was performed in 2 of them. Eight patients underwent stereotactic cerebral biopsy and the results of pathological examination were compared with the MRI findings.

RESULTSAll the 34 cases had low signals in T1WI but high signals in T2WI. Extensive involvement of the hemispheres beyond the cerebellar tentorium, brain stem and cerebellum was identified in 85.3% of the cases, and less than 10% had lesions involving only one of these three structures. Most of the lesions involved mainly the white matter, and 91.2% of the cases showed involvement of the bilateral hemispheres. Specific MRI features were found to help in HE diagnosis: lesions compromising the hemispheres beyond the cerebellar tentorium presented with the pattern resembling the Chinese character "eight", a hollow pattern was found in brain stem involvement, and "butterfly wing" pattern in cerebellar involvement. The abnormal signals were caused mainly by demyelination and vacuole formation in the white matter, and these vacuoles resulted in the sponge-like appearance of the white matter containing fluid.

CONCLUSIONMRI can provide strong evidence for HE diagnosis and can be informative of the involvement, position and aggravation of the lesions with some characteristic MRI features. In most of the cases, a MRI-based diagnosis can be consistent with histopathological diagnosis.

Adult ; Brain ; pathology ; Brain Diseases ; diagnosis ; etiology ; Female ; Heroin Dependence ; complications ; pathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Reproducibility of Results ; Sensitivity and Specificity

OBJECTIVETo summarize the clinical and radiographic characteristics of heroin spongiform leukoencephalopathy (HSLE).

METHODSA clinical analysis of 42 cases of HSLE was conducted.

RESULTSClinically, the patients with HSLE all had a positive history of inhalation of heated heroin vapor with acute or subacute onset in most cases, presenting initially cerebellar signs. Pyramidal tract lesion was frequently involved, but the sensory system usually remained normal. The consciousness disturbances may occur in the serious cases. Brain CT and magnetic resonance imaging (MRI) revealed extensive symmetric white matter lesions in the cerebrum and cerebellum, and in serious cases, the midbrain and pons could be damaged. Spongiform vacuoles degeneration of white matter characterized the predominant pathological changes.

CONCLUSIONSpongiform leukoencephalopathy should be considered in a patient who shows acute cerebellar signs and reports a history of inhaling heated heroin vapor, and a definite diagnosis of HSLE can be made in such a case upon the identification of typical CT or MRI findings.

Adult ; Brain ; pathology ; Female ; Heroin Dependence ; complications ; Humans ; Leukoencephalopathies ; chemically induced ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To investigate effect of home-based rehabilitation on performance in a functional independence measure (FIM) in patients with heroin-associated encephalopathy (HE). METHODS: A total of 56 patients with HE were divided into a family rehabilitation management group (treatment group, n=30) and a control group (n=26). The patients in the home-based rehabilitation management group were put on a rehabilitation program and then followed-up; those in the control group were only followed-up. Both groups were evaluated with FIM at discharge and 3, 6, and 12 months after discharge. RESULTS: FIM in the treatment group was remarkably better than that in the control group at 3, 6, 12 months after discharge (79.5±16.3 vs 62.3± 14.6, 88.2±20.0 vs 65.5±13.4, 99.6±21.2 vs 68.7±15.8; all P< 0.05). In the rehabilitation group, FIM of the patients receiving 3, 6, and 12 months of rehabilitation therapy was significantly higher than that at the time of discharge (P<0.01). CONCLUSION Home-based rehabilitation management has significant effect on the FIM in patients with HE.
Activities of Daily Living ; Adolescent ; Adult ; Aged ; Brain Diseases ; etiology ; rehabilitation ; China ; Female ; Heroin Dependence ; complications ; pathology ; rehabilitation ; Home Care Services ; Humans ; Male ; Middle Aged ; Recovery of Function ; Young Adult

OBJECTIVETo investigate the pathological characteristics of heroin spongiform leukoencephalopathy (HSLE).

METHODSCerebral tissue specimens were obtained from 15 patients with HSLE and the histological observations under optical and electron microscopes were carried out by HE, Bielschowsky's, and chromotrope 2R-brilliant green staining.

RESULTSHSLE was characterized primarily by spongiform vacuolar degeneration of the cerebral white matter. Neurons in the gray matter, Purkinje and granular cells in the cerebella remain intact in all the cases. Numerous vacuoles, which merged to form larger cavities, appeared in the damaged white matter, and the axons survived in the deep white matter. The myelin sheath in the cerebellar white matter sustained more severe damages than those in the cerebral white matter. No vacuoles or lymphocyte infiltration occurred in the small peripheral vessels.

CONCLUSIONHSLE is pathologically characterized by vacuolar degeneration due to primary damage of the myelin, and the spongiform vacuolar degeneration is closely associated with the severity of demyelination in the white matter.

Adult ; Autopsy ; Canavan Disease ; etiology ; pathology ; Cerebellum ; chemistry ; pathology ; ultrastructure ; Cerebral Cortex ; chemistry ; pathology ; ultrastructure ; Female ; Heroin Dependence ; complications ; Humans ; Male ; Microscopy, Electron ; Middle Aged ; Neurons ; chemistry ; pathology ; Purkinje Cells ; chemistry ; pathology ; Staining and Labeling ; methods ; Young Adult