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Allan H. Ropper, MD; Richard Blair, MD

Arch Neurol. 2003;60:1605-1606.

Background  Acute symmetric deep cerebellar lesions suggest toxic exposure.

Objective  To describe a patient with striking neurologic and magnetic resonance image features.

Design  Case report.

Setting  Emergency department and office.

Methods  Personal observation.

Results  A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome.

Conclusions  An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.

From the Neurology Service and Department of Radiology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass.

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