Chasing the dragon: New knowledge for an old practice

Juan P. Cordova, Sabish Balan, Jorge Romero, Aleksandr Korniyenko, Carlos L. Alviar, Alberto Paniz-Mondolfi, Raymonde Jean

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Heroin administration by "chasing the dragon," whereby the user places freebase heroin on aluminum foil, heats it below with a flame, and inhales the pyrolysate through a straw, can be associated with the rare development of a delayed-onset spongiform leukoencephalopathy. We report the case of a 46-year-old woman with a psychiatric diagnosis of depression and heroin dependence by "chasing the dragon" admitted with features of altered mental status and later development of catatonia, abulia, and akinetic mutism. A brain magnetic resonance image evidenced bilateral symmetric high-signal lesions in the white matter of the cerebrum and cerebellum on T2-weighted images compatible with toxic leukoencephalopathy. The patientÊs condition resolved after a hospital stay of 2 months with supportive treatment. Acute onset of neurobehavioral changes, including confusion, apathy, and cerebellar signs in a person with exposure to heroin, should prompt one to consider toxic leukoencephalopathy as a cause of presentation.

Original languageEnglish (US)
Pages (from-to)52-55
Number of pages4
JournalAmerican Journal of Therapeutics
Issue number1
StatePublished - Jan 1 2014
Externally publishedYes


  • chasing the dragon
  • heroin
  • spongiform leukoencephalopathy

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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