case_images: PMC10860508_01
case_images: Axial T2-weighted slices depict diffuse bilateral white matter lesions respecting the U fibres (arrowhead) and exhibiting the characteristic "spongiform" appearance described in HLE, this refers to the visualization of vacuoles with a quasi-liquid signal located between the nerve fibres (arrow). Abbreviation: HLE = heroin-induced leukoencephalopathy.
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case_images: PMC10860508_01_uaad004f1.jpg
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case_images: T1-weighted sequence, and hyperintense on T2-weighted and FLAIR images (Figure 1). These lesions spared subcortical U-fibres and presented a "vacuolated" appearance, particularly visible on the T2-weighted sequence.
case_images: Axial T2-weighted slices passing through the thalamus and the posterior cranial fossa, demonstrate involvement of the posterior limb of the internal capsule (arrow) and the middle cerebellar peduncle sign or MCP sign (arrowhead).
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case_images: Involvement of the posterior limb of the internal capsule extending to the corticospinal tract of the pons and symmetric involvement of the middle cerebellar peduncles (MCP sign) was also noted (Figure 2).
case_images: DWI images at two different levels illustrating diffusion restriction scattered within the white matter lesions (A, B), confirmed on the ADC cartography (C). Abbreviation: DWI = diffusion-weighted imaging.
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case_images: uaad004-F3
case_images: The lesions also showed peripheral restrictive areas observed on the diffusion sequence and apparent diffusion coefficient (ADC) cartography (Figure 3).