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BrainWaves #132 Teaching through clinical cases: Chasing the dragon

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.

Originally released: February 21, 2019

Heroin was originally marketed as a cough suppressant in 1898. (Obviously, people have discovered more uses for it since then.) One hundred years later, it has paved the way for a worldwide drug abuse epidemic. Dr. Mike Rubenstein presents this week's clinical case of a very particular type of heroin use and a rare form of neurotoxicity.

Produced by James E Siegler and Mike Rubenstein. Music courtesy of Heftone Banjo Orchestra, John Bartmann, Kai Engel, and Soft and Furious. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.


Alambyan V, Pace J, Miller B, et al. The Emerging Role of Inhaled Heroin in the Opioid Epidemic: A Review. JAMA Neurol. 2018 Nov 1;75(11):1423-1434. doi: 10.1001/jamaneurol.2018.1693. PMID 29987325

Kriegstein AR, Armitage BA, Kim PY. Heroin inhalation and progressive spongiform leukoencephalopathy. N Engl J Med 1997;336(8):589-90. PMID 9036319

Kriegstein AR, Shungu DC, Millar WS, et al. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology 1999;53(8):1765-73. PMID 10563626

Wolters EC, van Wijngaarden GK, Stam FC, et al. Leucoencephalopathy after inhaling "heroin" pyrolysate. Lancet 1982;2(8310):1233-7. PMID 6128545

We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode’s original release date.

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