BRIEF TOXICOLOGY COMMUNICATIONS “Chasing the Dragon”—Heroin-Associated

A 21-year-old male presented with acute ataxia. For 1 week, he became increasingly unbalanced, clumsy, and severely dysarthric. He sustained multiple falls and had difficulty walking. He admitted to inhaling heated heroin vapors twice in the past, the last time was 1 week prior to admission. His symptoms started acutely 24 h after that. He denied injecting heroin in the past as he had a known “needle phobia”. On examination, his speech was severely dysarthric. He demonstrated horizontal nystagmus and positive cerebellar signs bilaterally with inability to stand without assistance and falling backwards when unsupported. Serum toxicology screen was negative. MRI revealed symmetrical white matter hyperinten-sities with a “C-shaped ” lesion in the deep cerebella