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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)
- Cocaine
- Opioids and derivatives
- Heroin: IV use, inhaled ("chasing the dragon")
- Other derivatives include morphine, hydrocodone, oxycodone, codeine
- Cannabis/marijuana
- Tetrahydrocannabinol (THC) is major psychoactive substance
- THC → hemorrhage, ischemic strokes, reversible cerebral vasoconstriction syndrome (RCVS), vasculitis
- EtOH abuse: Interference with normal clotting ↑ risk of spontaneous hemorrhage and extent of hemorrhage due to primary pathology
- Traumatic brain injury
- Hypertensive cerebral vascular disease
- Benzodiazepines
- CNS depression → hypoxic injury, and direct myelinotoxic effect
- Polydrug abuse
- Amphetamines and derivatives
- May interfere with critical metabolic pathways
- Nitrous oxide (NO₂) 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)
- Many drugs (prescription, illicit, or street) have adverse effects on CNS
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
- Hampton WH et al: Substance abuse and white matter: findings, limitations, and future of diffusion tensor imaging research. Drug Alcohol Depend. 197:288-98, 2019
- Naveed MA et al: Neuroimaging of substance abuse. Neurographics. 9(1): 18-32, 2019
- Bodea S: CNS metabolism in high-risk drug abuse: insights gained from 1H-, 31P-MRS and PET. Radiologe. 58(Suppl 1):34-39, 2018
- Zehra A et al: Cannabis addiction and the brain: a review. J Neuroimmune Pharmacol. 13(4):438-52, 2018
- Bachi K et al: Vascular disease in cocaine addiction. Atherosclerosis. 262:154-62, 2017
- Garakani A et al: Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict. 25(5):358-69, 2016
- Niciu MJ et al: Neuroimaging in alcohol and drug dependence. Curr Behav Neurosci Rep. 1(1):45-54, 2014
- Fonseca AC et al: Drug abuse and stroke. Curr Neurol Neurosci Rep. 13(2):325, 2013
- Martindale JL: Imaging abnormalities associated with carbon monoxide toxicity. J Emerg Med. 44(6):1140-1, 2013
- Agarwal A et al: Toxic encephalopathy. J Gen Intern Med. 27(7):876-7, 2012
- Azeemuddin M et al: MRI findings in methanol intoxication: a report of three cases. J Pak Med Assoc. 62(10):1099-101, 2012
- 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
- Singh NN et al: Cannabis-related stroke: case series and review of literature. J Stroke Cerebrovasc Dis. 21(7):555-60, 2012
- Tamrazi B, Almast J. Your brain on drugs: imaging of drug-related changes in the central nervous system. Radiographics. 32(3):701-19, 2012
- Tormoehlen LM: Toxic leukoencephalopathies. Neurol Clin. 29(3):591-605, 2011
- Geibprasert S et al: Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol. 31(5):803-8, 2010
- Bega DS et al: Diffusion weighted imaging in heroin-associated spongiform leukoencephalopathy. Neurocrit Care. 10(3):352-4, 2009
- Sharma P et al: Toxic and acquired metabolic encephalopathies: MRI appearance. Am J Roentgenol. 193(3):879-86, 2009
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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)
- Cocaine
- Opioids and derivatives
- Heroin: IV use, inhaled ("chasing the dragon")
- Other derivatives include morphine, hydrocodone, oxycodone, codeine
- Cannabis/marijuana
- Tetrahydrocannabinol (THC) is major psychoactive substance
- THC → hemorrhage, ischemic strokes, reversible cerebral vasoconstriction syndrome (RCVS), vasculitis
- EtOH abuse: Interference with normal clotting ↑ risk of spontaneous hemorrhage and extent of hemorrhage due to primary pathology
- Traumatic brain injury
- Hypertensive cerebral vascular disease
- Benzodiazepines
- CNS depression → hypoxic injury, and direct myelinotoxic effect
- Polydrug abuse
- Amphetamines and derivatives
- May interfere with critical metabolic pathways
- Nitrous oxide (NO₂) 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)
- Many drugs (prescription, illicit, or street) have adverse effects on CNS
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
- Hampton WH et al: Substance abuse and white matter: findings, limitations, and future of diffusion tensor imaging research. Drug Alcohol Depend. 197:288-98, 2019
- Naveed MA et al: Neuroimaging of substance abuse. Neurographics. 9(1): 18-32, 2019
- Bodea S: CNS metabolism in high-risk drug abuse: insights gained from 1H-, 31P-MRS and PET. Radiologe. 58(Suppl 1):34-39, 2018
- Zehra A et al: Cannabis addiction and the brain: a review. J Neuroimmune Pharmacol. 13(4):438-52, 2018
- Bachi K et al: Vascular disease in cocaine addiction. Atherosclerosis. 262:154-62, 2017
- Garakani A et al: Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict. 25(5):358-69, 2016
- Niciu MJ et al: Neuroimaging in alcohol and drug dependence. Curr Behav Neurosci Rep. 1(1):45-54, 2014
- Fonseca AC et al: Drug abuse and stroke. Curr Neurol Neurosci Rep. 13(2):325, 2013
- Martindale JL: Imaging abnormalities associated with carbon monoxide toxicity. J Emerg Med. 44(6):1140-1, 2013
- Agarwal A et al: Toxic encephalopathy. J Gen Intern Med. 27(7):876-7, 2012
- Azeemuddin M et al: MRI findings in methanol intoxication: a report of three cases. J Pak Med Assoc. 62(10):1099-101, 2012
- 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
- Singh NN et al: Cannabis-related stroke: case series and review of literature. J Stroke Cerebrovasc Dis. 21(7):555-60, 2012
- Tamrazi B, Almast J. Your brain on drugs: imaging of drug-related changes in the central nervous system. Radiographics. 32(3):701-19, 2012
- Tormoehlen LM: Toxic leukoencephalopathies. Neurol Clin. 29(3):591-605, 2011
- Geibprasert S et al: Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol. 31(5):803-8, 2010
- Bega DS et al: Diffusion weighted imaging in heroin-associated spongiform leukoencephalopathy. Neurocrit Care. 10(3):352-4, 2009
- Sharma P et al: Toxic and acquired metabolic encephalopathies: MRI appearance. Am J Roentgenol. 193(3):879-86, 2009
