MRI of severe heroin-induced leukoencephalopathy

Axial T2-weighted magnetic resonance images of a severe case of heroin-induced leukoencephalopathy (A through C): In the medulla, signal abnormality is present in the regions of the pyramidal tracts, medial lemnisci, and the nucleus tractus solitaries posteriorly. The white matter of the cerebellar hemispheres is affected symmetrically with relative preservation of the grey matter of the dentate nuclei. Symmetrical signal abnormality extends throughout the supratentorial deep white matter including the posterior limbs of the internal capsules. Note preservation of the basal ganglia and thalami in this case. White matter change extends into the centrum semiovale and subcortical white matter bilaterally including that in the precentral and postcentral gyri (premotor area, primary motor area, and somatic sensory area).