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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. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course at https://upenn.cloud-cme.com/default.aspx?P=5aEID=54399. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. 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. REFERENCES Kriegstein AR, Armitage BA and Kim PY. Heroin inhalation and progressive spongiform leukoencephalopathy. The New England journal of medicine. 1997;336:589-90. Alambyan V, Pace J, Miller B, Cohen ML, Gokhale S, Singh G, Shun MC, Hammond A and Ramos-Estebanez C. The Emerging Role of Inhaled Heroin in the Opioid Epidemic: A Review. JAMA Neurol. 2018;75:1423-1434. Wolters EC, van Wijngaarden GK, Stam FC, Rengelink H, Lousberg RJ, Schipper ME and Verbeeten B. Leucoencephalopathy after inhaling "heroin" pyrolysate. Lancet. 1982;2:1233-7. Kriegstein AR, Shungu DC, Millar WS, Armitage BA, Brust JC, Chillrud S, Goldman J and Lynch T. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology. 1999;53:1765-73.