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Figure 1. T2 weighted (T2W) images of the brain. (a) Case 1, "chasing" toxicity at initial presentation (above) and at 6-month follow-up (below). Note the increased T2W signal within the cerebellar white matter with some sparing of the dentate nuclei; involvement of the anterior horns (motor) of the brainstem grey matter and the corticospinal tracts; anterior thalami; posterior limb of the internal capsule, with sparing of the anterior limb; splenium of the corpus callosum; posterior corona radiata; and the white matter of the occipital, parietal, posterior temporal and posterior frontal lobes, with sparing of the sub-cortical white matter. (b) Case 2, chasing toxicity at initial presentation, showing similar features to Case 1 to a greater extent, however, and with the addition of abnormal signal in the right globus pallidus. (c) Case 3, no heroin exposure, 11 days after presentation (motion artefact on initial exam). Abnormal increased T2W signal involving the globus palladi and supratentorial white matter with sparing of the sub-cortical white matter. The cerebellum and brainstem are not affected.
