Your Brain on Drugs: Imaging of Drug-related Changes in the Central Nervous System

Abstract

Drug abuse is a substantial problem in society today and is associated with significant morbidity and mortality. Various drugs are associated with serious complications affecting the brain, and it is critical to recognize the imaging findings of these complications to provide prompt medical management. The central nervous system (CNS) is a target organ for drugs of abuse as well as specific prescribed medications. Drugs of abuse affecting the CNS include cocaine, heroin, alcohol, amphetamines, toluene, and cannabis. Prescribed medications or medical therapies that can affect the CNS include immunosuppressants, antiepileptics, nitrous oxide, and total parenteral nutrition. The CNS complications of these drugs include neurovascular complications, encephalopathy, atrophy, infection, changes in the corpus callosum, and other miscellaneous changes. Imaging abnormalities indicative of these complications can be appreciated at both magnetic resonance (MR) imaging and computed tomography (CT). It is critical for radiologists to recognize complications related to drugs of abuse as well as iatrogenic effects of various medications. Therefore, diagnostic imaging modalities such as MR imaging and CT can play a pivotal role in the recognition and timely management of drug-related complications in the CNS.

Psychostimulants and Cognition: A Continuum of Behavioral and Cognitive Activation

“…The Drug Enforcement Administration of the United States considers cocaine a Schedule II drug, determining it to be highly addictive and dangerous to the user's health, but appropriate for restricted medicinal use (Controlled Substances Act (21 USC x 812, 2002)). Both prolonged and acute use of cocaine can lead to a wealth of cardiotoxic (Kloner et al, 1992) and neurovascular (Tamrazi and Almast, 2012) complications, the severity of which is dependent upon the dose used. However, cocaine inhibits Na + channels at high concentrations, and historically was widely used as a local anesthetic, especially in dentistry and ophthalmology (Catterall and Mackie, 2006).…”

Imaging in phenytoin induced neurotoxicity: a case series

“…Along with the drug's action, cerebellar atrophy post phenytoin therapy in epileptic patients is also attributed to seizure mediated cell loss secondary to ischemic injury. 3 A higher dosage intake for a longer period of use is associated with more pronounced atrophic changes. Serum phenytoin levels have been observed to be higher in patients with moderate to severe cerebellar changes than those with mild or no cerebellar changes.…”

Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis

“…[1][2][3][4]8,9,15,22,25,32 Figure 2 shows that COM and hypertension are independent predictors for ICH risk. The joint effect increased the HR further to 9.52 (95% CI 5.20-17.5) for COM patients with comorbidities of hypertension, diabetes, and CKD.…”

“…Studies have shown that intravenous drug use-related systemic infections increase the risk of cerebral vascular infection and subsequent rupture of mycotic aneurysms in cerebral arterioles. 9,15,32 Among noninfectious factors, pathological changes in the cerebral arterioles, including proliferation and death of arteriolar smooth muscle cells and arteriolar ectasia with microaneurysm formation 31 in the cerebral arterioles, may subsequently lead to the rupture of arteriolar microaneurysms, causing ICH. 10,28,31 These noninfectious pathological changes can be triggered by some conventional risk factors for ICH, such as hypertension, diabetes, hyperlipidemia, and chronic kidney disease (CKD).…”