Substantia Nigra MR Imaging Signal Changes and Cardiomyopathy Following Prenatal Exposure to Cocaine and Heroin: Fig 1.

Abstract

SUMMARY: Exposure to cocaine in utero results in behavioral and neurodevelopmental abnormalities that persist into adulthood. Conventional MR imaging has generally failed to reveal the expected structural lesions to explain these clinical findings. We report a case of focal MR imaging signalintensity changes in the substantia nigra, locus ceruleus, and other selected nerve tracts and nuclei in a child exposed prenatally to cocaine and other drugs. The patient also had dilated cardiomyopathy. Maternal cocaine use during pregnancy is a widespread problem, which leads to a spectrum of behavioral, cognitive, and motor dysfunctions. Animal and human studies have attempted to define the specific neurologic centers damaged by prenatal cocaine exposure. Since 1991, attempts to document MR imaging changes in the brains of animals and humans exposed to cocaine in utero have produced mixed results. Findings of brain MR imaging of exposed children are generally reported to be anatomically normal. 1,2The substantia nigra, locus ceruleus, ventral caudate, and ventral tegmental area have been implicated as focal targets of cocaine, resulting in neuronal activation, reduced cell attenuation, and apoptosis.3,4 Additionally, prenatal exposure to cocaine has been associated with cardiac arrhythmias, congestive heart failure, cardiorespiratory arrest, and death. 5 We present a case of MR imaging changes in the substantia nigra and several other focal midbrain and brain stem centers in a child exposed to cocaine and heroin in utero. The patient also had severe left ventricular dysfunction at presentation. Case ReportThe mother of our patient used crack cocaine, heroin, alcohol, and prescription quetiapine fumarate and smoked 2 packs of cigarettes per day throughout pregnancy. Methamphetamine abuse was also mentioned in 1 emergency department report. The patient was born full term via cesarean delivery, weighing 7 pounds, 13 ounces (3.5 kg). Apgar scores were 9 and 9 at 1 and 5 minutes. The patient was in the care of his biologic family for the first 2-3 months of life, but physical abuse and neglect were suspected during this time. He was removed from the home and was eventually placed in foster care.The patient was referred to our center for failure to thrive with longstanding developmental and growth delays. At the time of presentation to pediatric neurology, the patient was 15 months old. On the basis of the Provence Birth to Three Developmental Profile, gross motor skills were at a 5-month level; language skills were at a 9-month level; and fine motor, cognitive, self-help, and social/emotional skills were at a 10-month level.Neurologic examination demonstrated mildly reduced muscle tone, a persistent truncal incurvation reflex, lack of lateral and anterior propping reflex, and dynamic spasticity of the hands, with the tendency to keep them closed. Deep tendon reflexes were symmetric, and Babinski reflexes were absent. Fine and gross motor tremors were variably reported by different observers, not including the patient's pediatr...

Toxic Leukoencephalopathy after Heroin Abuse without Heroin Vapor Inhalation

“…Subsequent reports have been described across Europe [2,3,5,7,9,14,[20][21][22][24][25][26][27][28][29][30], in the USA [6,12,17], Austra- lia [23], Canada [8,11,13,16], as well as a few cases from Taiwan [10,18,19] and Hong Kong [15]. However, reports of heroin-associated leukoencephalopathy remain seldom considering the large number of heroin addicts.…”

“…Moreover, as similar leukoencephalopathies have been reported in people using heroin by other means than inhaling heroin vapor [17,19,[22][23][24][25], it is arguable if heroin itself is toxic and/or if the way of heroin application matters.…”

Imaging Cognitive Deficits in Drug Abuse

“…Some of the volumetric differences, particularly thinner cortex in part of the right lateral OFC, may be moderately involved in cognitive and behavioral difficulties more frequently experienced by opiate and poly-substance-exposed children. Arnold et al (2008) found that exposure to cocaine in utero results in behavioral and neurodevelopmental abnormalities that persist into adulthood. The authors report a case of focal MR imaging signal-intensity changes in the substantia nigra, locus ceruleus, and other selected nerve tracts and nuclei in a child exposed prenatally to cocaine and other drugs.…”

Toxic leukoencephalopathy after intravenous heroin injection: a case with clinical and radiological reversibility

“…Toxic leukoencephalopathies have been more commonly described after heroin smoking, but also after heroin injection [5][6][7], intranasal administration [7], ingestion [8], and intrauterine transmission [9].…”