Download PDF
Fortschr Neurol Psychiatr 2004; 72(1): 26-35
DOI: 10.1055/s-2003-812455
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Spongiforme Leukenzephalopathie nach Inhalation von illegal gehandeltem Heroin und bei Kohlenmonoxid-Intoxikation

Spongiform Leucoencephalopathy After Inhaling Illicit Heroin and Due to Carbonmonoxide-IntoxicationP.  J.  Egan1 , F.-W.  Becker1 , F.  Schumm2
  • 1Neuroradiologische Abteilung Christophsbad Göppingen, Fachkrankenhaus Neurologie und Psychiatrie (Chefarzt: Dr. med. F.-W. Becker)
  • 2Klinik für Neurologie, Neurophysiologie und Frührehabilitation, Christophsbad Göppingen (Chefarzt: Prof. Dr. med. F. Schumm)
Univ.-Prof. Dr. med. Jürgen Peiffer zum 81. Geburtstag gewidmet
Further Information

Publication History

Publication Date:
27 January 2004 (online)

    Permissions and Reprints

Zusammenfassung

Nach dem Rauchen von illegal gehandeltem Heroin wie auch nach Kohlenmonoxid-Intoxikation kann sich eine spongiforme Leukenzephalopathie entwickeln, die klinisch zunächst durch eine überwiegend psychiatrische Symptomatik, dann durch neurologische Ausfälle auffällig wird und in einigen Fällen zum Tode führt. Nach einer Darstellung epidemiologischer und kulturhistorischer Aspekte des Rauchens von Opiaten werden kennzeichnende neuroradiologische (Hypodensität der weißen Substanz in der CCT, Signalabweichung in der MRT) und neuropathologische Befunde (intramyelinäre Vakuolisation) beschrieben. Pathophysiologisch ist ein primäres Marklagerödem wahrscheinlich. Die Besonderheiten des Stoffwechsels der Oligodendrozyten legen eine zusätzliche Dysfunktion der Mitochondrien nahe. Bisher fehlende Therapieoptionen begründen die Notwendigkeit zur Klärung der Ätiologie bei weltweit zunehmender Neigung zum Rauchen von Heroin.

Abstract

A spongiform leucoencephalopathy sometimes develops as a result of inhaling illicit heroin as well as due to carbonmonoxide-intoxication. Clinically psychiatric symptoms precede a neurological deterioration. Some patients die. After a brief description of several epidemiological and historico-cultural aspects regarding the smoking of opiates, the typical neuroradiological signs such as hypodensity of the white matter in CCT and signal alterations in MRT, and neuropathological sequelae such as intramyelinic vacuolisation are listed. Pathophysiologically an edema of the white matter in the beginning is suspected. Second, a dysfunction of the mitochondria is addressed relying on the particular metabolism of the oligodendrocytes. Since smoking of heroin is an increasingly preferred way of application in all continents and therapeutic options are still lacking, the need of further explanation of the underlying processes is stressed.

Literatur

  • 1 Wolters E C, Stam F C, Lousberg R J, Wijngaarden G K van, Rengelink H, Schipper M E, Verbeeten B. Leucoencephalopathy after inhaling „heroin” pyrolisate.  Lancet. 1982;  2 1233-1237
    PubMedGoogle Scholar
  • 2 Schiffer D, Brignolio F, Giordana T, Mongini T, Migheli A, Palmucci L. Spongiform encephalopathy in addicts inhaling pre-heated heroin.  Clin Neuropathol. 1985;  4 174-180
    PubMedGoogle Scholar
  • 3 Hungerbühler H, Waespe W. Leukenzephalopathie nach Inhalation von Heroin-Pyrolysat.  Schweiz Med Wochenschr. 1990;  120 1801-1805
    PubMedGoogle Scholar
  • 4 Sempere A P, Posada I, Ramo C, Cabello A. Spongiform leucoencephalopathy after inhaling heroin.  The Lancet (letter). 1991;  338 320
    PubMedGoogle Scholar
  • 5 Poen Tan T, Algra P R, Valk J, Wolters E C. Toxic leukoencephalopathy after inhalation of poisoned heroin: MR findings.  AJNR. 1994;  15 175-178
    PubMedGoogle Scholar
  • 6 Stoltenburg-Didinger G, Wiese J, Fink U. Diffuse progressive multifokale spongiöse Leukoencephalopathie nach Inhalation von Heroin - Ein Fallbericht.  Akt Neurol. 1995;  22 107-110
    PubMedGoogle Scholar
  • 7 Celius E G, Andersson S. Leucoencephalopathy after inhalation of heroin: a case report.  J Neurol Neurosurg Psychiatry. 1996;  60 694-695
    PubMedGoogle Scholar
  • 8 Weber W, Henkes H, Möller P, Bade K, Kühne D. Toxic spongiform leucoencephalopathy after inhaling heroin vapour.  Eur Radiol. 1998;  8 749-755
    CrossrefPubMedGoogle Scholar
  • 9 Scheuerle A, Seidl S, Egan P J, Schachenmayr W. Spongiforme Leukenzephalopathie nach Heroininhalation.  Rechtsmedizin. 2000;  10 110-113
    CrossrefPubMedGoogle Scholar
  • 10 Haan J, Müller E, Gerhard L. Spongiöse Leukodystrophie nach Drogenmissbrauch.  Nervenarzt. 1983;  54 489-490
    PubMedGoogle Scholar
  • 11 Kriegstein A R, Armitage B A, Millar W S, Shungu D C, Brust J C, Goldmann J E, Lynch T. Toxic heroin-induced spongiform leukoencephalopathy in two american patients.  Neurology. 1998;  50 A81-A82
    PubMedGoogle Scholar
  • 12 Kriegstein A R, Shungu D C, Millar W S, Armitage B A, Brust J C, Chillrud S, Golgmann J, Lynch T. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation („chasing the dragon”).  Neurology. 1999;  53 1765-1773
    CrossrefPubMedGoogle Scholar
  • 13 Brust J C. Neurological aspects of substance abuse. Butterworth-Heinemann 1993
    Google Scholar
  • 14 Stam F C. Leukoencephalopathies due to intoxications. In: Koetsier JC (ed.). Demyelinating diseases (Handbook of clinical neurology). 1985 47: 551-581
    Google Scholar
  • 15 Brust J C, Richter R W. Quinine amblyopia related to heroin addiction.  Ann Int Med. 1971;  74 84-86
    PubMedGoogle Scholar
  • 16 Frand U I, Shim C S, Williams M H. Sequential studies of pulmonary function.  Ann Intern Med. 1972;  77 29-35
    PubMedGoogle Scholar
  • 17 Schwartzfarb L, Singh G, Marcus D. Heroin-associated rhabdomyolysis with cardiac involvement.  Arch Intern Med. 1977;  137 1255-1257
    CrossrefPubMedGoogle Scholar
  • 18 Loizou L A, Boddie H G. Polyradiculopathy associated with heroin abuse.  J Neurol Neurosurg Psychiatry. 1978;  41 855-857
    PubMedGoogle Scholar
  • 19 Kaye R, Fainstat M. Cerebral vasculitis associated with cocaine abuse.  JAMA. 1987;  258 2104-2106
    CrossrefPubMedGoogle Scholar
  • 20 King J, Richards M, Tress B. Cerebral arteritis associated with heroin abuse.  Med J Aust. 1978;  2 444-445
    PubMedGoogle Scholar
  • 21 Glick R P, Anson J A. Vasculitis related to substance abuse. In: Churg A, Churg J (eds.). Systemic vasculitis. Tokyo, New York: Igaku-Shoin 1991: 315-325
    Google Scholar
  • 22 Brust J C. Opiate addiction and toxicity. In: Vinken PJ, Bruyn GW, Wolff FA (eds.). Intoxications of the nervous system II (Handbook of Clinical Neurology). 1995 65: 349-361
    Google Scholar
  • 23 Gossop M, Griffiths P, Strang J. Chasing the dragon: a comparison of heroin chasers and injectors seen by a London community drug team.  Brit J Addict. 1988;  83 1159-1162
    PubMedGoogle Scholar
  • 24 Griffiths P, Gossop M, Powis B, Strang J. Extent and nature of transitions of route among heroin addicts in treatment - preliminary data from the Drug Transitions Study (UK Transitions Report).  Brit J Addict. 1992;  87 485-491
    PubMedGoogle Scholar
  • 25 Strang J, Griffiths P, Gossop M. Heroin smoking by ‘chasing the dragon’: origins and history.  Addiction. 1997;  92 673-683
    CrossrefPubMedGoogle Scholar
  • 26 Jahresbericht über den Stand der Drogenproblematik in der Europäischen Union. 1998: 3-25
    Google Scholar
  • 27 Fuente L de la, Barrio G, Bravo M, Royuela L. Heroin smoking by “chasing the dragon”: its evolution in Spain.  Addiction (letters). 1999;  94 444-446
    PubMedGoogle Scholar
  • 28 Smolka M, Schmidt L G. The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome.  Addiction. 1999;  94 1191-1198
    CrossrefPubMedGoogle Scholar
  • 29 Huizer H. Analytical studies on illicit heroin. V. Efficacy of volatilisation during heroin smoking.  Pharm Weekbl (Sci). 1987;  9 203-211
    PubMedGoogle Scholar
  • 30 Westermeyer J. The switch from opium to heroin smoking.  Addiction (commentaries). 1997;  92 686-687
    PubMedGoogle Scholar
  • 31 San L. Why is the administration route of heroin changing?.  Addiction (commentaries). 1997;  92 688-689
    PubMedGoogle Scholar
  • 32 Cone E J. Recent discoveries in pharmacokinetics of drugs of abuse.  Toxicol Lett. 1998;  102 - 103 97-101
    CrossrefPubMedGoogle Scholar
  • 33 Darke S, Zador D. Fatal heroin ‘overdose’: a review.  Addiction. 1996;  91 1765-1772
    CrossrefPubMedGoogle Scholar
  • 34 Benowitz N L. Clinical pharmacology of inhaled drugs of abuse: implications in understanding nicotine dependence.  NIDA Research Monograph. 1990;  99 12-29
    PubMedGoogle Scholar
  • 35 Cook C E. Pyrolytic characteristics, pharmacokinetics, and bioavailability of smoked heroin, cocaine, phencyclidine, and methamphetamine.  NIDA-research-monograph. 1991;  115 6-23
    PubMedGoogle Scholar
  • 36 Levine S R, Brust J C, Futrell N, Brass L M, Blake D, Fayad P, Schultz L R, Millikan C H, Ho K-L, Welch K M. A comparative study of the cerebrovascular complications of cocaine: Alkaloidal versus hydrochloride - a review.  Neurology. 1991;  41 1173-1177
    PubMedGoogle Scholar
  • 37 Evans S M, Cone E J, Henningfield J E. Arterial and venous cocaine plasma concentrations in humans: relationship to route of administration, cardiovascular effects and subjective effects.  J Pharmacol Exp Ther. 1996;  279 1345-1356
    PubMedGoogle Scholar
  • 38 Cook C E, Brine D R. Pyrolysis products of heroin.  J Forensic Sci. 1985;  30 251-261
    PubMedGoogle Scholar
  • 39 Erzouki H K, Allen A C, Newman A H, Goldberg S R, Schindler C W. Effects of cocaine metabolites and cocaine pyrolysis products on the hindbrain cardiac and respiratory centers of the rabbit.  Life Sci. 1995;  57 1861-1868
    CrossrefPubMedGoogle Scholar
  • 40 Eskes D, Brown J K. Heroin-caffeine-strychnine mixtures - Where and why?.  Bull Narcot. 1975;  27 67-69
    PubMedGoogle Scholar
  • 41 Mo B P, Way E L. An assessment of inhalation as a mode of administration of heroin by addicts.  J Pharmac exp Ther. 1966;  154 142-151
    PubMedGoogle Scholar
  • 42 Larm L C. “Chasing the dragon”: how did it evolve?.  Addiction (commentaries). 1997;  92 685
    CrossrefPubMedGoogle Scholar
  • 43 Jenkins A, Keenan R M, Henningfield J E, Cone E J. Pharmacokinetics and pharmacodynamics of smoked heroin.  J Anal Toxicol. 1994;  18 317-330
    PubMedGoogle Scholar
  • 44 Swift W, Maher L, Sunjic S. Transitions between routes of heroin administration: a study of Caucasian and Indochinese heroin users in south-western Sydney, Australia.  Addiction. 1999;  94 71-82
    CrossrefPubMedGoogle Scholar
  • 45 Kalant H. Supply reduction vs. demand reduction: the uses of history.  Addiction (commentaries). 1997;  92 689-690
    PubMedGoogle Scholar
  • 46 Kolb D, Nail C R, Gunderson E K. Differences in family characteristics of heroin injectors and inhalers.  J Nerv Ment Dis. 1974;  158 446-449
    PubMedGoogle Scholar
  • 47 Musto D F. Opium, cocaine and marijuana in american history.  Sci Am. 1991;  265 40-47
    PubMedGoogle Scholar
  • 48 Kalant H. Opium revisited: a brief review of its nature, composition, non medical use and relative risks.  Addiction. 1997;  92 (3) 267-277
    CrossrefPubMedGoogle Scholar
  • 49 Paulshock B Z. William Heberden and Opium - some relief to all.  NEJM. 1983;  308 53-56
    PubMedGoogle Scholar
  • 50 Dreser H. Über die Wirkung einiger Derivate des Morphins auf die Atmung.  Arch f d ges Physiol. 1898;  72 485-521
    CrossrefPubMedGoogle Scholar
  • 51 Helpern M. Fatalities from narcotic addiction in New York City, Incidence, circumstances, and pathologic findings.  Hum Pathol. 1972;  3 (1) 13-21
    PubMedGoogle Scholar
  • 52 Pickworth W B, Henningfield J E. Smokable drugs: pharmacological basis for consumer appeal.  Addiction (commentaries). 1997;  92 691-692
    PubMedGoogle Scholar
  • 53 Weisman M, Lerner N, Vogel W, Schnoll S H, Banford T. Quality of street heroin.  N Engl J Med. 1973;  289 698-699
    PubMedGoogle Scholar
  • 54 Bundeskriminalamt .Rauschgiftjahresbericht. 1998
    Google Scholar
  • 55 Bundeskriminalamt .Rauschgiftjahresbericht. 1999
    Google Scholar
  • 56 Gruhzit C C. Pharmacological investigation and evaluation of the effects of combined barbiturate and heroin inhalation by addicts.  Bull Narcot. 1958;  10 8-11
    PubMedGoogle Scholar
  • 57 Schmidbauer W, Scheidt J vom. Handbuch der Rauschdrogen. Frankfurt: Fischer Taschenbuch Verlag 1992
    Google Scholar
  • 58 Cramer A. Anatomischer Befund im Gehirn bei einer Kohlenoxydgasvergiftung.  Centralbl f Allg Pathol und Pathol Anat. 1891;  13 545-550
    PubMedGoogle Scholar
  • 59 Grinker R R. Über einen Fall von Leuchtgasvergiftung mit doppelseitiger Pallidumerweichung und schwerer Degeneration des tieferen Großhirnmarklagers.  Z f ges Neurol und Psych. 1925;  98 433-456
    PubMedGoogle Scholar
  • 60 Jervis G A, Kindwall J A. Schilder's disease in ergotamine intoxication.  Am J Psychiatry. 1942;  98 650-655
    PubMedGoogle Scholar
  • 61 Schwedenberg T H. Leukoencephalopathy following carbon monoxide asphyxia.  J Neuropathol Exp Neurol. 1959;  18 597-608
    PubMedGoogle Scholar
  • 62 Lindenberg R. Patterns of CNS vulnerability in acute hypoxaemia, including anaesthesia accidents. In: Schadé JP, McMenemey WH (eds.). Selective vulnerability of the brain in hypoxaemia. Oxford: Blackwell Scientific Publications 1963: 189-209
    Google Scholar
  • 63 Sudo K. Über einen Fall mit ausgedehnten fleckförmigen Entmarkungen als Folge eines protrahierten Ödems nach akuter Morphium-Intoxikation.  Kyushu Shinkei Seishin Igaku. 1968;  14 198-206
    PubMedGoogle Scholar
  • 64 Lipski J, Stimmel B, Donoso E. The effect of heroin and multiple drug abuse on the electrocardiogram.  Am Heart J. 1973;  86 663-668
    CrossrefPubMedGoogle Scholar
  • 65 Richter R W, Pearson J, Bruun B, Challenor Y B, Brust J C, Baden M M. Neurological complications of addiction to heroin.  Bull NY Acad Med. 1973;  49 (1) 3-21
    PubMedGoogle Scholar
  • 66 Riße M, Weiler G. Heroinsucht als seltene Ursache einer symmetrischen Pallidumnekrose.  Z Rechtsmed. 1984;  93 227-235
    PubMedGoogle Scholar
  • 67 Roulet Perez E, Maeder P, Rivier L, Deonna T. Toxic leucoencephalopathy after heroin ingestion in a 21/2-year-old child.  The Lancet. 1992;  340 729
    PubMedGoogle Scholar
  • 68 Feigin I, Budzilovich G, Weinberg S, Ogata J. Degeneration of white matter in hypoxia, acidosis and edema.  J Neuropathol Exp Neurol. 1973;  32 125-143
    PubMedGoogle Scholar
  • 69 Maschke M, Fehlings T, Kastrup O, Wilhelm H W, Leonhardt G. Toxic leukoencephalopathy after intravenous consumption of heroin and cocaine with unexpected clinical recovery.  J Neurol. 1999;  246 850-851
    PubMedGoogle Scholar
  • 70 Bertram M, Egelhoff T, Schwarz S, Schwab S. Toxic leukencephalopathy following “ecstasy” ingestion.  J Neurol. 1999;  246 617-618
    PubMedGoogle Scholar
  • 71 Verity M A. Toxic disorders. In: Greenfieldaposs Neuropathology, 6th ed., London: Arnold 1997: 755-811
    Google Scholar
  • 72 Love S, Wiley C A. Viral diseases. In: Graham DI, Lantos PL (eds.). Greenfieldaposs Neuropathology, 7th ed. Arnold 2002 2: 1-105
    Google Scholar
  • 73 Oehmichen M. Intoxikationen. In: Peiffer J, Schröder JM, Paulus W (Hrsg.). Neuropathologie, 3. Aufl. Berlin, Heidelberg: Springer 2002: 395-433
    Google Scholar
  • 74 Olsson Y. Protective barriers in the peripheral nervous system to neurotoxic agents. In: Herken H, Hucho F (eds.). Selective neurotoxicity. Berlin, Heidelberg, New York: Springer 1992: 29-65
    Google Scholar
  • 75 Ernst A, Zirbrak J D. Carbon monoxide poisoning.  NEJM. 1998;  339 1603-1608
    CrossrefPubMedGoogle Scholar
  • 76 Moser H W. Leukoencephalopathies caused by metabolic disorders. In: Vinken PJ, Bruyn GW, Klawans HL, Koetsier JC (eds.). Handbook of clinical neurology. Demyelinating diseases 1985 3 (47): 583-604
    Google Scholar
  • 77 Lapresle J, Fardeau M. Les leuco-encéphalopathies de l'intoxication oxycarbonée.  Acta Neuropathol. 1966;  6 327-348
    CrossrefPubMedGoogle Scholar
  • 78 Lapresle J, Fardeau M. The central nervous system and carbon monoxide poisoning. II. Anatomical study of brain lesions following intoxication with carbon monoxide (22 cases).  Prog Brain Res. 1967;  24 31-74
    PubMedGoogle Scholar
  • 79 Plum F, Posner J B, Hain R F. Delayed neurological detoriation after anoxia.  Arch Intern Med. 1962;  110 18-25
    PubMedGoogle Scholar
  • 80 Roos R A. Neurological complications of carbon monoxide intoxication. In: de Wolff FA (ed.). Handbook of clinical neurology. Intoxications of the nervous system. Part I 1994 64: 31-38
    Google Scholar
  • 81 Brucher J M. La leucoencéphalopthie de l'intoxication oxycarbonée.  Revue Neurologique. 1962;  106 731-744
    PubMedGoogle Scholar
  • 82 Louria D B, Hensle T, Rose J. The major medical complications of heroin addiction.  Ann Intern Med. 1967;  67 1-22
    PubMedGoogle Scholar
  • 83 Weimann W, Marenholtz F von. Doppelseitige Linsenkernerweichung nach akuter Morphiumvergiftung.  Zschr Ges Neurol Psychiat. 1928;  105 297-308
    PubMedGoogle Scholar
  • 84 Richardson J C, Chambers R A, Heywood P M. Encephalopathies of anoxia and hypoglycemia.  AMA Arch Neurol. 1959;  1 178-190
    PubMedGoogle Scholar
  • 85 Steinberg A D, Karliner J S. The clinical spectrum of heroin pulmonary edema.  Arch Intern Med. 1968;  122 122-127
    CrossrefPubMedGoogle Scholar
  • 86 Korenke H D, Pribilla O. Suicid durch einmalige Inhalation von Tetrachlorkohlenstoff (CCl4) mit Leukoencephalopathie.  Arch Toxikol. 1969;  25 109-126
    PubMedGoogle Scholar
  • 87 Salama J, Gherardi R, Amiel H, Poirier J, Delaporte P, Gray F. Post-anoxic delayed encephalopathy with leukoencephalopathy and non-hemorrhagic cerebral amyloid angiopathy.  Clin Neuropathol. 1986;  5 153-156
    PubMedGoogle Scholar
  • 88 Artigas J, Niedobitek F, Grosse G, Heise W, Gosztonyi G. Spongiform encephalopathy in AIDS dementia complex: Report of 5 cases.  J Acq Imm Def Syndr. 1989;  2 374-381
    PubMedGoogle Scholar
  • 89 Protass L M. Delayed postanoxic encephalopathy after heroin use.  Ann Intern Med. 1971;  74 738-739
    PubMedGoogle Scholar
  • 90 Knaap M S van der, Valk J. Selective vulnerability. In: Magnetic resonance of myelin, myelination, and myelin disorders. 2nd ed. Berlin, Heidelberg, New York 1995: 22-30
    Google Scholar
  • 91 Knaap M S van der, Valk J. Posthypoxid-ischemic damage. In: Magnetic resonance of myelin, myelination, and myelin disorders. 2nd ed. Berlin, Heidelberg, New York: Springer Verlag 1995: 370-373
    Google Scholar
  • 92 Knaap M S van der, Valk J. Delayed posthypoxid leukoencephalopathy of maturity. In: Magnetic resonance of myelin, myelination, and myelin disorders. 2nd ed. Berlin, Heidelberg, New York: Springer Verlag 1995: 387-389
    Google Scholar
  • 93 Nusbaum A O, Fung K-M, Atlas S W. White matter diseases and inherited metabolic disorders. In: Atlas SW (ed.). Magnetic resonance imaging of the brain and spine, 3rd ed. Lippincott: Williams & Wilkins 2002: 457-563
    Google Scholar
  • 94 Rudkin T M, Arnold D L. MR-Spectroscopy and the biochemical basis of neurological disease. In: Atlas SW (ed.). Magnetic resonance imaging of the brain and spine, 3rd ed. Lippincott: Williams & Wilkins 2002: 2021-2040
    Google Scholar
  • 95 Falini A, Barkovich A J, Calabrese G, Origgi D, Triulzi F, Scotti G. Progressive brain failure after diffuse hypoxic ischemic brain injury: a serial MR and proton MR spectroscopic study.  AJNR. 1998;  19 648-652
    PubMedGoogle Scholar
  • 96 Kobayashi K, Isaki K, Fukutani Y, Kurachi M, Eboshida A, Matsubara R, Yamaguchi N. CT findings of the interval form of carbon monoxide poisoning compared with neuropathological findings.  Eur Neurol. 1984;  23 34-43
    PubMedGoogle Scholar
  • 97 Kamada K, Houkin K, Aoki T, Koiwa M, Kashiwaba T, Iwasaki Y, Abe H. Cerebral metabolic changes in delayed carbon monoxide sequelae studied by proton MR spectroscopy.  Neuroradiology. 1994;  36 104-106
    CrossrefPubMedGoogle Scholar
  • 98 Vieregge P, Klostermann W, Blümm R G, Borgis K J. Carbon monoxide poisoning: clinical, neurophysiological, and brain imaging observations in acute disease and follow-up.  J Neurol. 1989;  236 478-481
    PubMedGoogle Scholar
  • 99 Kono E, Kono R, Shida K. Computerized tomographies of 34 patients at the chronic stage of acute carbon monoxide poisoning.  Arch Psychiatr Nervenkr. 1983;  233 271-278
    CrossrefPubMedGoogle Scholar
  • 100 Strassmann G, Sturner W, Helpern M. Gehirnschädigungen, insbesondere Linsenkernerweichungen bei Heroinsüchtigen, nach Barbituratvergiftung, Spättod nach Erhängen und Herzstillstand in der Narkose.  Beitr Gerichtl Med. 1969;  25 236-242
    PubMedGoogle Scholar
  • 101 Andersen S N, Skullerud K. Hypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts.  Forensic Sci Int. 1999;  102 51-59
    CrossrefPubMedGoogle Scholar
  • 102 Chang K H, Han M H, Kim H S, Wie B a, Han M C. Delayed encephalopathy after acute carbon monoxide intoxication: MR imaging features and distribution of cerebral white matter lesions.  Radiology. 1992;  184 117-122
    PubMedGoogle Scholar
  • 103 Uchino A, Hasuo K, Shida K, Matsumoto S, Yasumori K, Masuda K. MRI of the brain in chronic carbon monoxide poisoning.  Neuroradiology. 1994;  36 399-401
    CrossrefPubMedGoogle Scholar
  • 104 Kastrup A, Li T-Q, Takahashi A, Glover G H, Moseley M E. Functional magnetic resonance imaging of regional cerebral blood oxigenation changes during breath holding.  Stroke. 1998;  29 2641-2645
    PubMedGoogle Scholar
  • 105 Teksam M, Casey S O, Michel E, Liu H, Truwit C L. Diffusion-weighted imaging findings in carbon monoxide poisoning.  Neuroradiology. 2002;  44 109-113
    CrossrefPubMedGoogle Scholar
  • 106 Banati R B, Gehrmann J, Schubert P, Kreutzberg G W. Cytotoxicity of microglia.  Glia. 1993;  7 111-118
    CrossrefPubMedGoogle Scholar
  • 107 Graeber M B, Blakemore W F, Kreutzberg G W. Cellular pathology of the central nervous system. In: Graham DI, Lantos PL (eds.). Greenfield's Neuropathology, 7th ed. Arnold 2002 1: 123-191
    Google Scholar
  • 108 Davis J N. The use of small animals to study the effects of hypoxia. In: Fahn S (ed.). Advances in Neurology. Vol. 26. New York: Raven Press 1979: 167-172
    Google Scholar
  • 109 Gogate N, Verma L, Zhou J M, Milward E, Rusten R, OaposConnor M, Kufta C, Hudson L, Dubois-Dalcq M. Plasticity in the adult human oligodendrocyte lineage.  J Neurosci. 1994;  14 (8) 4571-4587
    PubMedGoogle Scholar
  • 110 Hahm H, Ferszt R, Müller J, Cervós-Navarro J. Topography of diffuse brain edema. In: Cervós-Navarro J, Ferszt R (eds.). Advances in Neurology. Vol. 28. New York: Raven Press 1980: 299-315
    Google Scholar
  • 111 Horita N, Ando S, Seino S, Hagiwara I. Experimental carbon monoxide leucoencephalopathy in the cat.  J Neuropathol Exp Neurol. 1980;  39 197-211
    PubMedGoogle Scholar
  • 112 Connor J R, Menzies S L. Relationship of iron to oligodendrocytes and myelination.  Glia. 1996;  17 83-93
    CrossrefPubMedGoogle Scholar
  • 113 Gaab M R, Poch B, Heller V. Oxygen tension, oxygen metabolism, and microcirculation in vasogenic brain edema. In: Long D et al (eds.). Advances in Neurology. Vol. 52. New York: Raven Press 1990: 247-256
    Google Scholar
  • 114 Penney D G. Acute carbon monoxide poisoning: animal models: A review.  Toxicology. 1990;  62 123-160
    CrossrefPubMedGoogle Scholar
  • 115 Shillito F H, Drinker C K, Shaughnessy T J. The problem of nervous and mental sequelae in carbon monoxide poisoning.  JAMA. 1936;  106 669-674
    PubMedGoogle Scholar
  • 116 Ginsberg M D. Delayed neurological detoriation following hypoxia. In: Fahn S (ed.). Advances in Neurology. Vol. 26. New York: Raven Press 1979: 21-44
    Google Scholar
  • 117 Jacob H. Über die diffuse Hemisphärenmarkerkrankung nach Kohlenoxidvergiftung bei Fällen mit klinisch intervallärer Verlaufsform.  Zschr Ges Neurol Psych. 1939;  167 161-179
    PubMedGoogle Scholar
  • 118 Jacob H. Über die diffuse Markdestruktion im Gefolge eines Hirnödems.  Zschr Ges Neurol Psychiat. 1939;  168 382-395
    PubMedGoogle Scholar
  • 119 Adachi M, Feigin I. Cerebral oedema and water content of normal white matter.  J Neurol Neurosurg Psychiatr. 1966;  29 446-450
    PubMedGoogle Scholar
  • 120 Ironside J W, Pickard J D. Raised intracranial pressure, oedema and hydrocephalus. In: Graham DI, Lantos PL (eds). Greenfield's Neuropathology, 7th ed. Arnold 2002 1: 193-231
    Google Scholar
  • 121 Okeda R, Funata N, Takano T, Miyazaki Y, Higashino F, Yokoyama K, Manabe M. The pathogenesis of carbon moboxide encephalopathy in the acute phase - physiological and morphological correlation.  Acta Neuropathol (Berl). 1981;  54 1-10
    CrossrefPubMedGoogle Scholar
  • 122 Baethmann A, Oettinger W, Rothenfußer W, Kempski O, Unterberg A, Geiger R. Brain edema factors: current state with particular reference to plasma constituents and glutamate. In: Cervós-Navarro J, Ferszt R (ed.). Advances in Neurology. Vol. 28. New York: Raven Press 1980: 171-195
    Google Scholar
  • 123 Fishman R A, Chan P H. Metabolic basis of brain edema. In: Cervós-Navarro J, Ferszt R (eds.). Advances in Neurology. 28 New York: Raven Press 1980: 207-215
    Google Scholar
  • 124 Bazán N G, Rodríguez de Turco E B. Membrane lipids in the pathogenesis of brain edema: Phospholipids and arachidonic acid, the earliest membrane components changed on the onset of ischemia. In: Cervós-Navarro J, Ferszt R (eds.). Advances in Neurology. Vol. 28. New York: Raven Press 1980: 197-205
    Google Scholar
  • 125 Okeda R, Song S-Y, Funta N, Higashino F. An experimental study of the pathogenesis of Grinker's myelinopathy in carbon monoxide intoxication.  Acta Neuropathol (Berl). 1983;  59 200-206
    CrossrefPubMedGoogle Scholar
  • 126 Hirano A. Fine structure of edematous encephalopathy. In: Cervós-Navarro J, Ferszt R (eds.). Advances in Neurology. 28 New York: Raven Press 1980: 83-97
    Google Scholar
  • 127 Ginsberg M D, Myers R E. Experimental carbon monoxide encephalopathy in the primate. I. Physiology and metabolic aspects.  Arch Neurol. 1974;  30 202-208
    PubMedGoogle Scholar
  • 128 Lübbers D W. Physiologie der Gehirndurchblutung. In: Gänshirt H (Hrsg.). Der Hirnkreislauf. Stuttgart: Georg Thieme Verlag 1972: 214-260
    Google Scholar
  • 129 Berry M, Butt A M, Wilkin G, Perry H. Structure and function of glia in the central nervous system. In: Graham DI, Lantos PL (eds.). Greenfield's Neuropathology, 7th ed. Arnold 2002 1: 75-121
    Google Scholar
  • 130 Pannese E. Neurocytology. Stuttgart: Georg Thieme Verlag 1994
    Google Scholar
  • 131 Martin D L. Synthesis and release of neuroactive substances by glial cells.  Glia. 1992;  5 81-94
    CrossrefPubMedGoogle Scholar
  • 132 Auer R N, Sutherland G R. Hypoxia and related conditions. In: Graham DI, Lantos PL (eds.). Greenfield's Neuropathology, 7th ed. Arnold 2002 1: 233-280
    Google Scholar
  • 133 Siesjö B K. Cerebral circulation and metabolism.  J Neurosurg. 1984;  60 883-908
    PubMedGoogle Scholar
  • 134 Baumann N, Pham-Dinh D. Biology of oligodendrocyte and myelin in the mammalian central nervous system.  Physiol Rev. 2001;  81 (2) 871-927
    PubMedGoogle Scholar
  • 135 Löffler G. Stoffwechsel von Glukose und Glykogen. In: Löffler G, Petrides PE (Hrsg.). Biochemie und Pathobiochemie, 7. Auflage. Berlin, Heidelberg, New York: Springer 2003: 395-431
    Google Scholar
  • 136 Sánchez-Abarca L I, Tabernero A, Medina J M. Oligodendrocytes use lactate as source of energy and as a precursor of lipids.  Glia. 2001;  36 321-329
    CrossrefPubMedGoogle Scholar
  • 137 Potanos J N, Wolf A. Cytochemical localization of oxidative enzymes in human nerve cells and neuroglia.  J Neuropathol Exp Neurol. 1959;  18 617-635
    PubMedGoogle Scholar
  • 138 Lumsden S E. Pathogenic mechanisms in the leucoencephalopathies in anoxic-ischaemic process, in disorders of the blood and in intoxications. In: Vinken PI, Bruyn GW (eds.). Handbook of clinical neurology. Vol. 9. North-Holland Publishing Group 1970: 572-663
    Google Scholar
  • 139 Benn T, Halfpenny C, Scolding N. Glial cells as targets for cytotoxic immune mediators.  Glia. 2001;  36 200-211
    CrossrefPubMedGoogle Scholar
  • 140 Bauer J, Rauschka H, Lassmann H. Inflammation in the nervous system: The human perspective.  Glia. 2001;  36 235-342
    CrossrefPubMedGoogle Scholar
  • 141 Courville C B. The process of demyelination in the central nervous system. IV. Demyelination as a delayed residual of carbon monoxide asphyxia.  J Nerv Ment Dis. 1957;  125 534-546
    PubMedGoogle Scholar
  • 142 Blass J P, Gibson G E. Consequences of mild, graded hypoxia. In: Fahn S (ed.). Advances in Neurology. Vol. 26. New York: Raven Press 1979: 229-250
    Google Scholar
  • 143 Simon R P. Hypoxia versus ischemia.  Neurology. 1999;  52 7-8
    PubMedGoogle Scholar
  • 144 Ginsberg M D, Myers R E, McDonagh B F. Experimental carbon monoxide encephalopathy in the primate. II. Clinical aspects, neuropathology, and physiologic correlation.  Arch Neurol. 1974;  30 209-216
    PubMedGoogle Scholar
  • 145 Ginsberg M D, Hedley-White T, Richardson E P. Hypoxic-ischemic leukoencephalopathy in man.  Arch Neurol. 1976;  33 5-14
    PubMedGoogle Scholar
  • 146 Myers R E. A unitary theory of causation of anoxic and hypoxic brain pathology. In: Fahn S (ed.). Advances in Neurology. Vol. 26. New York: Raven Press 1979: 195-213
    Google Scholar
  • 147 Kempski O, Staub F, Jansen M, Baethmann A. Molecular mechanisms of glial swelling in acidosis. In: Long et al (eds.). Advances in Neurology. Vol. 52. New York: Raven Press 1990: 39-45
    Google Scholar
  • 148 Brucher J M. Leukoencephalopathies in anoxic-ischemic processes. In: Koetsier JC (ed.). Demyelinating diseases (Handbook of clinical neurology). 1985 47: 525-549
    Google Scholar
  • 149 Herre S, Pragst F, Rießelmann R, Roscher S, Tenczer J, Klug E. Zur toxikologischen Bewertung der Lokalanästhetika Lidocain und Tetracain bei Drogentodesfällen.  Rechtsmedizin. 1999;  9 174-183
    CrossrefPubMedGoogle Scholar
  • 150 Challenor Y B, Richter W, Bruun B, Pearson J. Nontraumatic plexitis and heroin addiction.  JAMA. 1973;  225 (8) 958-961
    CrossrefPubMedGoogle Scholar
  • 151 Ell J J, Uttley D, Silver J R. Acute myelopathy in association with heroin addiction.  J Neurol Neurosurg Psychiatry. 1981;  44 448-450
    PubMedGoogle Scholar
  • 152 Citron B P, Halpern M, McCarron M, Lundberg G D, McCormick R, Pincus I J, Tatter D, Haverback B J. Necrotizing angiitis associated with drug abuse.  New Eng J Med. 1970;  283 1003-1011
    PubMedGoogle Scholar
  • 153 Bartholomé E. et al. (Hrsg) .In: Ullmanns Encyklopädie der toxischen Chemie, 4. Aufl. Neuheim, Deerfield Beach, Basel: Verlag Chemie 1981: 300
  • 154 Bartholomé E. et al (Hrsg) .In: Ullmanns Encyklopädie der toxischen Chemie, 4. Aufl. Neuheim, Deerfield Beach, Basel: Verlag Chemie 1983: 686
  • 155 Pfeiffer S E, Warrington A E, Bansal R. The oligodendrocyte and its many cellular processes.  Trends Cell Biol. 1993;  3 191-197
    CrossrefPubMedGoogle Scholar
  • 156 Knaap M S van der, Valk J. Defects of mitochondrial DNA. In: Magnetic resonance of myelin, myelination, and myelin disorders. 2nd ed. Berlin, Heidelberg, New York 1995: 146-157
    Google Scholar
  • 157 Brandt U. Redoxreaktionen, Sauerstoff und oxidative Phosphorylierung. In: Löffler G, Petrides PE (Hrsg.). Biochemie und Pathobiochemie, 7. Aufl. Berlin, Heidelberg, New York: Springer 2003: 531-555
    Google Scholar
  • 158 Rich P. The cost of living.  Nature. 2003;  421 583
    CrossrefPubMedGoogle Scholar
  • 159 Tunving K. Fatal outcome in drug addiction.  Acta psychiatr scand. 1988;  77 551-566
    PubMedGoogle Scholar
  • 160 Risser D, Schneider B. Drug-related deaths between 1985 and 1992 examined at the Institute of forensic medicine in Vienna, Austria.  Addiction. 1994;  89 851-857
    PubMedGoogle Scholar
  • 161 Püschel K. Drug-related death - an update.  Forensic Sci Int. 1993;  62 121-128
    CrossrefPubMedGoogle Scholar

Dr. med. Patrick John Egan

Christophsbad

Faurndauer Str. 16-18

73035 Göppingen

Email: PJEgan@t-online.de

      >