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Drug Abuse
Miral D. Jhaveri, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Many drugs (prescription, illicit, or street) have adverse effects on CNS
                • Major pathology is generally vascular or metabolic
                • Polydrug abuse (including EtOH) is common
              • Cerebrovascular disease caused by illicit drug use
                • Amphetamines and derivatives
                  • Cocaine
                    • Cocaine hydrochloride (HCl) is water soluble, ingested via mucosal membrane
                    • Alkaloid form (freebase, crack) is smokable
                  • 3,4-methylenedioxymethamphetamine (MDMA, ecstasy)
                • Opioids and derivatives
                  • Heroin: IV use, inhaled ("chasing the dragon")
                  • Other derivatives include morphine, hydrocodone, oxycodone, codeine
                • Cannabis/marijuana
                • EtOH abuse: Interference with normal clotting increases risk of spontaneous hemorrhage and extent of hemorrhage due to primary pathology
                  • Traumatic brain injury
                  • Hypertensive cerebral vascular disease
              • May interfere with critical metabolic pathways
                • Nitrous oxide (N₂O) abuse → vitamin B12 inactivation → subacute combined degeneration
              • May lead to nutritional deficiencies
                • Chronic EtOH abuse → thiamine deficiency → Wernicke encephalopathy
              • Organ damage from chronic drug abuse
                • EtOH → liver failure → manganese deposition in basal ganglia (BG)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Other Modality Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Niciu MJ et al: Neuroimaging in Alcohol and Drug Dependence. Curr Behav Neurosci Rep. 1(1):45-54, 2014
                                          2. Fonseca AC et al: Drug abuse and stroke. Curr Neurol Neurosci Rep. 13(2):325, 2013
                                          3. Martindale JL: Imaging abnormalities associated with carbon monoxide toxicity. J Emerg Med. 44(6):1140-1, 2013
                                          4. Agarwal A et al: Toxic encephalopathy. J Gen Intern Med. 27(7):876-7, 2012
                                          5. Azeemuddin M et al: MRI findings in methanol intoxication: a report of three cases. J Pak Med Assoc. 62(10):1099-101, 2012
                                          6. Moreno-López L et al: Neural correlates of the severity of cocaine, heroin, alcohol, MDMA and cannabis use in polysubstance abusers: a resting-PET brain metabolism study. PLoS One. 7(6):e39830, 2012
                                          7. Singh NN et al: Cannabis-related stroke: case series and review of literature. J Stroke Cerebrovasc Dis. 21(7):555-60, 2012
                                          8. Tamrazi B, Almast J. Your brain on drugs: imaging of drug-related changes in the central nervous system. Radiographics. 32(3):701-19, 2012
                                          9. Tormoehlen LM: Toxic leukoencephalopathies. Neurol Clin. 29(3):591-605, 2011
                                          10. Geibprasert S et al: Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol. 31(5):803-8, 2010
                                          11. Bega DS et al: Diffusion weighted imaging in heroin-associated spongiform leukoencephalopathy. Neurocrit Care. 10(3):352-4, 2009
                                          12. Sharma P et al: Toxic and acquired metabolic encephalopathies: MRI appearance. Am J Roentgenol. 193(3):879-86, 2009
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Many drugs (prescription, illicit, or street) have adverse effects on CNS
                                                        • Major pathology is generally vascular or metabolic
                                                        • Polydrug abuse (including EtOH) is common
                                                      • Cerebrovascular disease caused by illicit drug use
                                                        • Amphetamines and derivatives
                                                          • Cocaine
                                                            • Cocaine hydrochloride (HCl) is water soluble, ingested via mucosal membrane
                                                            • Alkaloid form (freebase, crack) is smokable
                                                          • 3,4-methylenedioxymethamphetamine (MDMA, ecstasy)
                                                        • Opioids and derivatives
                                                          • Heroin: IV use, inhaled ("chasing the dragon")
                                                          • Other derivatives include morphine, hydrocodone, oxycodone, codeine
                                                        • Cannabis/marijuana
                                                        • EtOH abuse: Interference with normal clotting increases risk of spontaneous hemorrhage and extent of hemorrhage due to primary pathology
                                                          • Traumatic brain injury
                                                          • Hypertensive cerebral vascular disease
                                                      • May interfere with critical metabolic pathways
                                                        • Nitrous oxide (N₂O) abuse → vitamin B12 inactivation → subacute combined degeneration
                                                      • May lead to nutritional deficiencies
                                                        • Chronic EtOH abuse → thiamine deficiency → Wernicke encephalopathy
                                                      • Organ damage from chronic drug abuse
                                                        • EtOH → liver failure → manganese deposition in basal ganglia (BG)

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Other Modality Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Niciu MJ et al: Neuroimaging in Alcohol and Drug Dependence. Curr Behav Neurosci Rep. 1(1):45-54, 2014
                                                                                  2. Fonseca AC et al: Drug abuse and stroke. Curr Neurol Neurosci Rep. 13(2):325, 2013
                                                                                  3. Martindale JL: Imaging abnormalities associated with carbon monoxide toxicity. J Emerg Med. 44(6):1140-1, 2013
                                                                                  4. Agarwal A et al: Toxic encephalopathy. J Gen Intern Med. 27(7):876-7, 2012
                                                                                  5. Azeemuddin M et al: MRI findings in methanol intoxication: a report of three cases. J Pak Med Assoc. 62(10):1099-101, 2012
                                                                                  6. Moreno-López L et al: Neural correlates of the severity of cocaine, heroin, alcohol, MDMA and cannabis use in polysubstance abusers: a resting-PET brain metabolism study. PLoS One. 7(6):e39830, 2012
                                                                                  7. Singh NN et al: Cannabis-related stroke: case series and review of literature. J Stroke Cerebrovasc Dis. 21(7):555-60, 2012
                                                                                  8. Tamrazi B, Almast J. Your brain on drugs: imaging of drug-related changes in the central nervous system. Radiographics. 32(3):701-19, 2012
                                                                                  9. Tormoehlen LM: Toxic leukoencephalopathies. Neurol Clin. 29(3):591-605, 2011
                                                                                  10. Geibprasert S et al: Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol. 31(5):803-8, 2010
                                                                                  11. Bega DS et al: Diffusion weighted imaging in heroin-associated spongiform leukoencephalopathy. Neurocrit Care. 10(3):352-4, 2009
                                                                                  12. Sharma P et al: Toxic and acquired metabolic encephalopathies: MRI appearance. Am J Roentgenol. 193(3):879-86, 2009