Download PDF
Neuroradiologie Scan 2013; 03(02): 127-145
DOI: 10.1055/s-0032-1325917
Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Das Gehirn auf Drogen: Bildgebung drogenassoziierter Veränderungen im zentralen Nervensystem[1]

Your brain on drugs: imaging of drug-related changes in the central nervous system
Benita Tamrazi
,
Jeevak Almast
Further Information

Publication History

Publication Date:
22 April 2013 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Drogenmissbrauch ist in der heutigen Gesellschaft ein schwerwiegendes Problem, das mit signifikanter Morbidität und Mortalität einhergeht. Verschiedene Drogen haben massive Auswirkungen auf das Gehirn, und es ist von entscheidender Bedeutung, die radiologischen Befunde dieser Komplikationen zu erkennen, um umgehend die angemessene medizinische Versorgung einleiten zu können. Das zentrale Nervensystem ist ein Zielorgan für Drogen ebenso wie für bestimmte Medikamente. Zu den Drogen, die das zentrale Nervensystem schädigen, zählen Kokain, Heroin, Alkohol, Amphetamine, Toluol und Cannabis. Verschreibungspflichtige Medikamente und Behandlungsmaßnahmen, die sich auf das zentrale Nervensystem auswirken können, sind Immunsuppressiva, Antiepileptika, Distickstoffmonoxid und totale parenterale Ernährung. Die das zentrale Nervensystem betreffenden Komplikationen dieser Medikamente umfassen neurovaskuläre Komplikationen, Enzephalopathie, Atrophie, Infektionen, Veränderungen des Corpus callosum und verschiedene andere Veränderungen. Radiologische Anomalien, die auf solche Komplikationen hinweisen, zeigen sich sowohl in der Magnetresonanztomografie als auch in der Computertomografie. Für den Radiologen ist es entscheidend, mit Drogen assoziierte Komplikationen ebenso zu erkennen wie iatrogene Auswirkungen verschiedener Medikamente. Diagnostische Bildgebungsverfahren, wie Magnetresonanztomografie und Computertomografie, können daher eine zentrale Rolle bei der Erkennung und zügigen Behandlung von drogenbedingten, das zentrale Nervensystem betreffenden Komplikationen spielen.

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.

1 © 2012 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2012; 32: 701 – 719. Online published in 10.1148 /rg.323115115. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

  • Literatur

  • 1 Borne J, Riascos R, Cuellar H et al. Neuroimaging in drug and substance abuse part II: opioids and solvents. Top Magn Reson Imaging 2005; 16 : 239-245
    CrossrefGoogle Scholar
  • 2 Toossi S, Hess CP, Hills NK et al. Neurovascular complications of cocaine use at a tertiary stroke center. J Stroke Cerebrovasc Dis 2010; 19 : 273-278
    CrossrefGoogle Scholar
  • 3 Fessler RD, Esshaki CM, Stankewitz RC et al. The neurovascular complications of cocaine. Surg Neurol 1997; 47 : 339-345
    CrossrefGoogle Scholar
  • 4 Rojas R, Riascos R, Vargas D et al. Neuroimaging in drug and substance abuse part I: cocaine, cannabis, and ecstasy. Top Magn Reson Imaging 2005; 16 : 231-238
    CrossrefGoogle Scholar
  • 5 Levine SR, Brust JCM, Futrell N et al. Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine. N Engl J Med 1990; 323 : 699-704
    CrossrefGoogle Scholar
  • 6 Brown E, Prager J, Lee HY et al. CNS complications of cocaine abuse: prevalence, pathophysiology, and neuroradiology. AJR Am J Roentgenol 1992; 159 : 137-147
    CrossrefGoogle Scholar
  • 7 Silvestrelli G, Corea F, Micheli S et al. Clinical pharmacology and vascular risk. Open Neurol J 2010; 4: 64-72
    Google Scholar
  • 8 Geibprasert S, Gallucci M, Krings T. Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol 2010; 31: 803-808
    CrossrefPubMedGoogle Scholar
  • 9 Koch S, Sacco RL. Cocaine-associated stroke: Some new insights?. Nat Clin Pract Neurol 2008; 4 : 579
    CrossrefGoogle Scholar
  • 10 Erwin MB, Hoyle JR, Smith CH et al. Cocaine and accelerated atherosclerosis: insights from intravascular ultrasound. Int J Cardiol 2004; 93 : 301-303
    CrossrefGoogle Scholar
  • 11 Daras M, Tuchman AJ, Marks S. Central nervous system infarction related to cocaine abuse. Stroke 1991; 22 : 1320-1325
    CrossrefGoogle Scholar
  • 12 Sen S, Silliman SL, Braitman LE. Vascular risk factors in cocaine users with stroke. J Stroke Cerebrovasc Dis 1999; 8 : 254-258
    CrossrefGoogle Scholar
  • 13 Berman S, O’Neill J, Fears S et al. Abuse of amphetamines and structural abnormalities in the brain. Ann N Y Acad Sci 2008; 1141: 195-220
    Google Scholar
  • 14 Neiman J, Haapaniemi HM, Hillbom M. Neurological complications of drug abuse: pathophysiological mechanisms. Eur J Neurol 2000; 7 : 595-606
    CrossrefGoogle Scholar
  • 15 Bartlett E, Mikulis DJ. Chasing. “Chasing the dragon” with MRI: leukoencephalopathy in drug abuse. Br J Radiol 2005; 78: 997-1004
    CrossrefGoogle Scholar
  • 16 Keogh CF, Andrews GT, Spacey SD et al. Neuroimaging features of heroin inhalation toxicity: “chasing the dragon”. AJR Am J Roentgenol 2003; 180: 847-850
    CrossrefGoogle Scholar
  • 17 Offiah C, Hall E. Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy. Clin Radiol 2008; 63: 146-152
    CrossrefGoogle Scholar
  • 18 Besenski N, Rumboldt Z, Emovon O et al. Brain MR imaging abnormalities in kidney transplant recipients. AJNR Am J Neuroradiol 2005; 26: 2282-2289
    Google Scholar
  • 19 Bartynski WS, Tan HP, Boardman JF et al. Posterior reversible encephalopathy syndrome after solid organ transplantation. AJNR Am J Neuroradiol 2008; 29: 924-930
    CrossrefPubMedGoogle Scholar
  • 20 Sharma P, Eesa M, Scott JN. Toxic and acquired metabolic encephalopathies: MRI appearance. AJR Am J Roentgenol 2009; 193: 879-886
    CrossrefPubMedGoogle Scholar
  • 21 Lin JT, Wang SJ, Fuh JL et al. Prolonged reversible vasospasm in cyclosporin A-induced encephalopathy. AJNR Am J Neuroradiol 2003; 24: 102-104
    Google Scholar
  • 22 Kiemeneij IM, de Leeuw FE, Ramos LMP et al. Acute headache as a presenting symptom of tacrolimus encephalopathy. J Neurol Neurosurg Psychiatry 2003; 74: 1126-1127
    CrossrefGoogle Scholar
  • 23 Fugate JE, Claassen DO, Cloft HJ et al. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010; 85: 427-432
    CrossrefGoogle Scholar
  • 24 Eichler AF, Batchelor TT, Henson JW. Diffusion and perfusion imaging in subacute neurotoxicity following high-dose intravenous methotrexate. Neuro Oncol 2007; 9: 373-377
    CrossrefGoogle Scholar
  • 25 Inaba H, Khan RB, Laningham FH et al. Clinical and radiological characteristics of methotrexate-induced acute encephalopathy in pediatric patients with cancer. Ann Oncol 2008; 19: 178-184
    CrossrefPubMedGoogle Scholar
  • 26 Reddick WE, Glass JO, Helton KJ et al. Prevalence of leukoencephalopathy in children treated for acute lymphoblastic leukemia with high-dose methotrexate. AJNR Am J Neuroradiol 2005; 26: 1263-1269
    Google Scholar
  • 27 Hagan IG, Burney K. Radiology of recreational drug abuse. RadioGraphics 2007; 27: 919-940
    CrossrefGoogle Scholar
  • 28 Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol 2009; 44: 155-165
    CrossrefGoogle Scholar
  • 29 Zuccoli G, Santa Cruz D, Bertolini M et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 2009; 30: 171-176
    Google Scholar
  • 30 Bjork JM, Grant SJ, Hommer DW. Cross-sectional volumetric analysis of brain atrophy in alcohol dependence: effects of drinking history and comorbid substance use disorder. Am J Psychiatry 2003; 160: 2038-2045
    CrossrefGoogle Scholar
  • 31 Harper C. The neuropathology of alcohol-related brain damage. Alcohol Alcohol 2009; 44: 136-140
    CrossrefGoogle Scholar
  • 32 Chow KM, Szeto CC. Cerebral atrophy and skull thickening due to chronic phenytoin therapy. CMAJ 2007; 176 : 321-323
    Google Scholar
  • 33 Crooks R, Mitchell T, Thom M. Patterns of cerebellar atrophy in patients with chronic epilepsy: a quantitative neuropathological study. Epilepsy Res 2000; 41: 63-73
    CrossrefGoogle Scholar
  • 34 De Marcos FA, Ghizoni E, Kobayashi E et al. Cerebellar volume and long-term use of phenytoin. Seizure 2003; 12: 312-315
    CrossrefGoogle Scholar
  • 35 Meyerhoff DJ. Effects of alcohol and HIV infection on the central nervous system. Alcohol Res Health 2001; 25: 288-298
    Google Scholar
  • 36 Ansari AA. Drugs of abuse and HIV: a perspective. J Neuroimmunol 2004; 147: 9-12
    CrossrefGoogle Scholar
  • 37 Heinrich A, Runge U, Khaw AV. Clinicoradiologic subtypes of Marchiafava-Bignami disease. J Neurol 2004; 251: 1050-1059
    Google Scholar
  • 38 Ruiz-Martínez J, Martínez Pérez-Balsa A, Ruibal M et al. Marchiafava-Bignami disease with widespread extracallosal lesions and favourable course. Neuroradiology 1999; 41: 40-43
    CrossrefGoogle Scholar
  • 39 Tuntiyatorn L, Laothamatas J. Acute Marchiafava-Bignami disease with callosal, cortical, and white matter involvement. Emerg Radiol 2008; 15: 137-140
    CrossrefGoogle Scholar
  • 40 Johkura K, Naito M, Naka T. Cortical involvement in Marchiafava-Bignami disease. AJNR Am J Neuroradiol 2005; 26: 670-673
    Google Scholar
  • 41 Honda K, Nishimiya J, Sato H et al. Transient splenial lesion of the corpus callosum after acute withdrawal of antiepileptic drug: a case report. Magn Reson Med Sci 2006; 5: 211-215
    CrossrefGoogle Scholar
  • 42 Güven H, Delibaş S, Comoğlu SS. Transient lesion in the splenium of the corpus callosum due to carbamazepine. Turk Neurosurg 2008; 18: 264-270
    Google Scholar
  • 43 Pema PJ, Horak HA, Wyatt RH. Myelopathy caused by nitrous oxide toxicity. AJNR Am J Neuroradiol 1998; 19: 894-896
    Google Scholar
  • 44 Lin RJ, Chen HF, Chang YC et al. Subacute combined degeneration caused by nitrous oxide intoxication: case reports. Acta Neurol Taiwan 2011; 20: 129-137
    Google Scholar
  • 45 Shulman RM, Geraghty TJ, Tadros M. A case of unusual substance abuse causing myeloneuropathy. Spinal Cord 2007; 45: 314-317
    Google Scholar
  • 46 Quaghebeur G, Taylor WJ, Kingsley DPE et al. MRI in children receiving total parenteral nutrition. Neuroradiology 1996; 38: 680-683
    CrossrefGoogle Scholar