1
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Redmond A, Archontakis-Barakakis P, Chlorogiannis DD, Ntaios G, Mavridis T. Bilateral watershed infarcts due to hypoperfusion in the context of drug abuse: case report. Int J Neurosci 2024:1-5. [PMID: 38506559 DOI: 10.1080/00207454.2024.2333480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/16/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Watershed infarcts (WIs) are a distinct type of stroke with a varying clinical presentation that affects the border areas between the territories of two cerebral arteries and are typically associated with hemodynamic impairment and internal carotid artery stenosis. However, there is a paucity of data concerning its association with the history of recreational substance and drug abuse. METHODS/CASE REPORT This case report presents a unique instance of bilateral internal watershed infarcts in a 23-year-old male with a history of polysubstance abuse, including methadone and cocaine. The patient's presentation included confusion, lower limb weakness, and systemic complications such as acute liver injury and myonecrosis, underlying the complexity of the clinical scenario. RESULTS The investigation revealed no evidence of arterial stenosis or thrombosis, leading to the conclusion that the infarctions were likely precipitated by a total loss of consciousness due to substance abuse-related cerebral hypoperfusion and vasoconstriction. Methadone and cocaine, both implicated in vasoconstriction, lowering the seizure threshold and contributing to QTc prolongation, thus leading to loss of consciousness, were identified as potential triggers for the episode. CONCLUSIONS In the young adult population, it is important to consider drug abuse as an etiological trigger for watershed infarcts, whereas the multi-system involvement and atypical presentation highlight the need for a comprehensive approach.
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Affiliation(s)
- Aine Redmond
- Department of Neurology, Tallaght University Hospital (TUH)/The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | | | | | - George Ntaios
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Theodorοs Mavridis
- Department of Neurology, Tallaght University Hospital (TUH)/The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
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2
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Puac-Polanco P, Rovira À, Shah LM, Wiggins RH, Rivas Rodriguez F, Torres C. Imaging of Drug-Related Vasculopathy. Neuroimaging Clin N Am 2024; 34:113-128. [PMID: 37951697 DOI: 10.1016/j.nic.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Illicit and recreational drugs, such as cocaine, heroin, amphetamines, and marijuana, can result in drug-related vasculitis or vasculopathy. Similarly, the use of certain antithyroid, oncologic, and immunosuppressive medications for therapeutic purposes can lead to vasculopathy. This in turn may result in significant complications in the central nervous system, including intracranial hemorrhage and stroke. Cocaine abuse can also lead to midline destructive lesions of the sinonasal complex. MR imaging, Vessel Wall imaging, and CT/CTA are valuable imaging tools for the evaluation of patients with suspected drug-induced vasculopathy or vasculitis. This article reviews the pathomechanism, clinical presentation, and imaging findings of vasculopathy related to drug abuse and prescribed medications.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Vall d'Hebron Passeig Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Lubdha M Shah
- Division of Neuroradiology, University of Utah, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Richard H Wiggins
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, University of Utah Health Sciences Center, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Francisco Rivas Rodriguez
- Radiology, Division of Neuroradiology, University of Michigan, 1500 East Medical Center Drive, B2A205 Ann Arbor, MI 48109-5302, USA
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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3
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Mallikarjun KS, Eldaya RW, Miller-Thomas MM, Orlowski HL, Parsons MS. Good Gone Bad: Complications of Chemotherapy, Immunotherapy, and Radiotherapy on the CNS. Curr Probl Diagn Radiol 2024; 53:133-149. [PMID: 37495483 DOI: 10.1067/j.cpradiol.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/24/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
With recent advancements in cancer therapy, especially immunotherapy, overall survival of many cancers has increased and patient toxicity has been reduced. However, many complications of traditional cancer therapy are still prevalent and complications of novel therapies are just beginning to appear. The neuroradiologist may be the first to visualize signs of these complications on imaging. This article describes the notable imaging findings of several unique and characteristic complications of CNS cancer therapy, including toxicities of chemotherapies, immunotherapies, and radiotherapy. Complications of chemotherapeutic agents covered include methotrexate-induced and disseminated necrotizing leukoencephalopathy, and chemotherapy-induced myelopathy. Immunotherapy complications included are Tacrolimus-related Optic Neuropathy, Rituximab and Immune reconstitution inflammatory syndrome-associated Progressive Multifocal Leukoencephalopathy, Bevacizumab-associated late radiation-induced neurotoxicity, and Ipilimumab-induced hypophysitis. Lastly, radiation-induced neurotoxicities are covered, including myelopathy, radiation necrosis, cerebral atrophy, leukoencephalopathy, optic neuropathy, mineralizing microangiopathy, stroke-like migraine attacks, osteonecrosis, and vasculopathies. Neuroradiologists will increasingly encounter patients who have undergone treatment with more than 1 therapeutic modality, resulting in overlapping findings as well. Recognition of the common complications of these therapies on imaging is critical to minimizing the effects of these potential short- and long-term complications.
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4
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Shrestha DB, Shtembari J, Achhami E, Adhikari L, Rengarajan D. Posterior Reversible Encephalopathy Syndrome in a Male With Polysubstance Abuse: A Case Report. Cureus 2023; 15:e34477. [PMID: 36874686 PMCID: PMC9981862 DOI: 10.7759/cureus.34477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurologic disorder with multiple etiologies. The signs and symptoms of PRES are non-specific, making the differential diagnosis broad. Although PRES is suspected clinically, a diagnosis requires characteristic findings on imaging. In patients with undiagnosed PRES, the coexistence of substance abuse can divert the care provider from pursuing imaging studies, leading to a missed diagnosis. We describe the case of a 51-year-old male who presented with altered mental status and was diagnosed with PRES despite having a positive urine drug screen.
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Affiliation(s)
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Eliz Achhami
- Department of Internal Medicine, Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, NPL
| | - Lukash Adhikari
- Department of Internal Medicine, Patan Academy of Health Sciences, Lalitpur, NPL
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5
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Sungura R, Shirima G, Spitsbergen J, Mpolya E, Vianney JM. A case-control study on the driving factors of childhood brain volume loss: What pediatricians must explore. PLoS One 2022; 17:e0276433. [PMID: 36584214 PMCID: PMC9803277 DOI: 10.1371/journal.pone.0276433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/07/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The brain volume loss also known as brain atrophy is increasingly observed among children in the course of performing neuroimaging using CT scan and MRI brains. While severe forms of brain volume loss are frequently associated with neurocognitive changes due to effects on thought processing speed, reasoning and memory of children that eventually alter their general personality, most clinicians embark themselves in managing the neurological manifestations of brain atrophy in childhood and less is known regarding the offending factors responsible for developing pre-senile brain atrophy. It was therefore the goal of this study to explore the factors that drive the occurrence of childhood brain volume under the guidance of brain CT scan quantitative evaluation. METHODS This study was a case-control study involving 168 subjects with brain atrophy who were compared with 168 age and gender matched control subjects with normal brains on CT scan under the age of 18 years. All the children with brain CT scan were subjected to an intense review of their birth and medical history including laboratory investigation reports. RESULTS Results showed significant and influential risk factors for brain atrophy in varying trends among children including age between 14-17(OR = 1.1), male gender (OR = 1.9), birth outside facility (OR = 0.99), immaturity (OR = 1.04), malnutrition (OR = 0.97), head trauma (OR = 1.02), maternal alcoholism (OR = 1.0), antiepileptic drugs & convulsive disorders (OR = 1.0), radiation injury (OR = 1.06), space occupying lesions and ICP (OR = 1.01) and birth injury/asphyxia (OR = 1.02). CONCLUSIONS Pathological reduction of brain volume in childhood exhibits a steady trend with the increase in pediatric age, with space occupying lesions & intracranial pressure being the most profound causes of brain atrophy.
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Affiliation(s)
- Richard Sungura
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela- African Institution of Science and Technology, Arusha, Tanzania
- * E-mail:
| | - Gabriel Shirima
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela- African Institution of Science and Technology, Arusha, Tanzania
| | - John Spitsbergen
- Department of Neuroscience, Western Michigan University, Kalamazoo, MI, United States of America
| | - Emmanuel Mpolya
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela- African Institution of Science and Technology, Arusha, Tanzania
| | - John-Mary Vianney
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela- African Institution of Science and Technology, Arusha, Tanzania
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6
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Wiesmann M. Strukturelle Gehirnveränderungen und Läsionen durch
den Konsum illegaler Drogen und Psychedelika. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1888-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungDrogen können sowohl die Funktion wie auch die Struktur des Gehirns
verändern. Gelegentlicher oder regelmäßiger Drogenkonsum
ist in der Bevölkerung weit verbreitet. Daher ist die Kenntnis
möglicher Nebenwirkungen und charakteristischer Bildbefunde bei
Untersuchungen des Gehirns für den klinischen Alltag wichtig. Dieser
Artikel beschreibt die für die am weitesten verbreiteten Substanzen
typischen Komplikationen und morphologisch-radiologischen Veränderungen.
Zu den möglichen Pathomechnismen gehören neurotoxische Effekte,
die zu Leukenzephalopathie oder Hirnatrophie führen können, und
vaskuläre Komplikationen wie Vasokonstriktion, Vaskulitis oder
Hypertonus, durch die es zu intrazerebralen Blutungen oder Infarkten kommen
kann. Da die klinische Präsentation oft unspezifisch ist, und die
betroffenen Patienten ihren Drogenkonsum häufig verschweigen, ist das
Erkennen typischer Bildbefunde essentiell für eine zuverlässige
Diagnosestellung und zielgerichtete Therapie.
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Affiliation(s)
- Martin Wiesmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie,
Uniklinik RWTH Aachen, Germany
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7
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Chan IYM, Syed R, Jurkiewicz MT. Natural history of pediatric morphine leukoencephalopathy on CT and MRI. Emerg Radiol 2022; 29:1055-1058. [PMID: 35948808 DOI: 10.1007/s10140-022-02084-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
An increased awareness of opioids and the imaging appearance in opioid overdose-related leukoencephalopathy has rapidly become crucial with respect to its identification by emergency radiologists. It is a potentially life-threatening condition and is associated with devastating neurological outcomes. Thus, early diagnosis and management are paramount. We report a rare case of toxic leukoencephalopathy in a 20-month-old male patient secondary to morphine overdose in the outpatient setting following discharge from uncomplicated urethroplasty. Although pediatric toxic leukoencephalopathy has been reported previously in the literature, our case report is unique as it involves morphine, a less commonly used opioid in the outpatient setting. Moreover, we have provided brain computed tomography and magnetic resonance imaging and highlighted findings in the acute and chronic stages of the disease trajectory. This case report highlights the importance for radiologists, especially those involved in emergency care, to have a high index of suspicion for toxic leukoencephalopathy, a potentially devastating but treatable condition.
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Affiliation(s)
- Ian Y M Chan
- Children's Hospital, London Health Science Centre, London, ON, Canada. .,Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - Raza Syed
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael T Jurkiewicz
- Children's Hospital, London Health Science Centre, London, ON, Canada.,Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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8
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McCullagh K, Castillo M, Zamora C. Headache Attributed to Non-vascular Intracranial Disorder: Neoplasms, Infections, and Substance Abuse. Neurol Clin 2022; 40:531-546. [PMID: 35871783 DOI: 10.1016/j.ncl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Evaluation of headaches warrants a careful history and neurologic assessment to determine the need for further workup and imaging. Identifying patients who are at risk for underlying pathology is important and this includes individuals with known or suspected malignancy and those who are immunocompromised and at increased risk for intracranial infection. While CT is helpful in the acute setting and to screen for intracranial hypertension, MRI is the modality of choice for the evaluation of underlying pathologies. Imaging in substance abuse may show injury related to direct toxicity or secondary to vascular complications.
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Affiliation(s)
- Kassie McCullagh
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
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9
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Rakocevic N, Alaslani OH, Torres CH. Case 303: Delayed Posthypoxic Leukoencephalopathy. Radiology 2022; 304:241-244. [PMID: 35727714 DOI: 10.1148/radiol.203756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY A 54-year-old man was found by paramedics in his home face-down at his computer desk with a substantially reduced level of consciousness. He had not contacted his family for more than 50 hours. The patient lived alone and was a heavy smoker with a history of alcohol abuse. His medical history was otherwise unremarkable, and there was no history of cancer, psoriasis, or rheumatoid arthritis, nor was there a history of methotrexate administration. At presentation to the emergency department, he was mildly hypotensive and was experiencing hypercapnic respiratory failure and acute renal failure with rhabdomyolysis. His toxicology screen was mildly positive for opiates. He received naloxone (Narcan; Emergent) with minimal effect. An unenhanced CT scan of the head was obtained. Of note, this patient's presentation predated the COVID-19 pandemic. He was admitted to the intensive care unit for decreased level of consciousness and respiratory failure. The decreased level of consciousness was thought to be secondary to seizure, as he developed seizurelike movements prior to intubation, probably in the context of intoxication or alcohol withdrawal. Electroencephalography revealed moderate bilateral cerebral dysfunction and encephalopathy, with no evidence of nonconvulsive seizures. He had a short course of intermittent hemodialysis and was discharged home 8 days later with an appointment for neurology follow-up. At discharge, he was at his cognitive and functional baseline. Approximately 3 weeks later, the patient was brought back to the emergency department for progressive confusion and decrease in balance. He became apathetic with reduced psychomotor activity and was no longer able to perform basic daily activities, such as cooking or bathing. He displayed bizarre behavior, such as staring at a wall for hours, and was somnolent, irritable, and inattentive. He eventually became incontinent of urine and stool. Results of a neurologic examination of the cranial nerves, motor function, sensation, and reflexes were normal. The results of blood work-up were grossly normal, and the results of an extensive toxicology work-up were negative. Repeat head CT was performed. MRI was ordered to further investigate the patient's encephalopathic presentation.
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Affiliation(s)
- Natalie Rakocevic
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
| | - Ohoud H Alaslani
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
| | - Carlos H Torres
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
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10
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Psychomotor Symptoms in Chronic Cocaine Users: An Interpretative Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031897. [PMID: 35162918 PMCID: PMC8835199 DOI: 10.3390/ijerph19031897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
According to the latest estimates, there are around 24.6 million cocaine users worldwide, and it is estimated that around a quarter of the population worldwide has used cocaine at some point in their lifetime. It follows that such widespread consumption represents a major risk for public health. Long-term use of cocaine, in addition to being related to many cerebral and cardiovascular diseases, is increasingly associated with a higher incidence of psychomotor symptoms and neurodegenerative disorders. In recent years, numerous studies have shown an increased risk of antipsychotic-induced extrapyramidal symptoms (EPSs) in patients with psychotic spectrum disorders comorbid with psychostimulant misuse, particularly of cocaine. In the present paper, we describe the case of a young patient on his first entry into a psychiatric setting with previous cocaine misuse who rapidly presented psychomotor symptoms and was poorly responsive to symptomatic therapy consisting of benzodiazepines and anticholinergics, in relation to the introduction of various antipsychotics (first, second, and third generation). Furthermore, we propose neurobiological mechanisms underlying the hypothesized increased vulnerability to psychomotor symptoms in chronic cocaine abusers. Specifically, we supposed that the chronic administration of cocaine produces important neurobiological changes, causing a complex dysregulation of various neurotransmitter systems, mainly affecting subcortical structures and the dopaminergic and glutamatergic pathways. We believe that a better understanding of these neurochemical and neurobiological processes could have useful clinical and therapeutic implications by providing important indications to increase the risk–benefit ratio in pharmacological choice in patients with psychotic spectrum disorders comorbid with a substance use disorder.
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11
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Lasocki A, Seymour J. Central nervous system manifestations of systemic haematological malignancies and key differentials. Clin Radiol 2022; 77:328-336. [DOI: 10.1016/j.crad.2022.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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12
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Alnasser SM. Drug and Chemical Poisoning Patterns in Makkah Region, Saudi Arabia. Drug Res (Stuttg) 2021; 72:148-155. [PMID: 34758501 DOI: 10.1055/a-1658-3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This research reveals that drugs and chemicals poisoning have been reported to have severe and fetal side effects on health provided by doctors in statistics and periodical records. This work aimed to explore the interaction among drug and chemical poisoning patterns concerning risk factors, especially gender, age, exposure circumstances, and outcomes in the Makkah region. A retrospective analysis was of clinical drug and chemical poisoning cases (2014-2015). The data were retrieved from the Department of Environmental and Occupational Health, Ministry of Health, Makkah, Saudi Arabia. The Saudi Arabia Ministry of Health received 1216 reports of drug and chemical poisoning during 2014-2015 in Makkah. This study has found that, the most affected gender was that of males (65%). The most affected age category with drug poisoning was over 15 years old (67%), but under 5 years for chemical poisoning (60%). The majority of drug poisoning cases are unknown drugs (42%), which accidental poisoning was a minority compared with other drug causes (27%). Chemical poisoning accidents were the majority causes of the recorded cases (63%). We reported healthy recovered without complications for most patients from drug and chemical poisoning (85-95%). Antidotes were administered in only (5%) of cases, and fatalities were reported (0.5% of cases). We have shown a flagrant increase in the number of people poisoned by drugs and chemical agents during 2015. Increases poisoning cases involved both genders and all studied age categories, especially males over 15 years up to 25 (drugs) and < 5 years (chemicals). Most cases were accidental (chemicals) and reported healthy recovery for most patients.
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13
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Arora M, Boruah DK, Thakker V, Bhanwra S. 'Phenytoin: Shepherd or Wolf in Disguise? Phenytoin-Induced Neurotoxicity: A Case Series. Neurol India 2021; 69:1014-1017. [PMID: 34507432 DOI: 10.4103/0028-3886.323888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Phenytoin is a commonly used antiepileptic drug for various types of seizure disorders except for absent seizures. Long-term dose-dependent neurological side effects of phenytoin therapy include cerebellar atrophy, cerebral atrophy, and brain stem atrophy. Skull hyperostosis, gum hypertrophy, and megaloblastic anemia are other known effects of long-term therapy. We present four cases depicting clinical and neuroimaging findings of phenytoin-induced toxicity.
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Affiliation(s)
- Manali Arora
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Deb K Boruah
- Department of Radio-Diagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Vishal Thakker
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Sangeeta Bhanwra
- Department of Pharmacology, Government Medical College, Punjab, India
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14
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Kumar P, Sharma A, Kumar D, Sharma L. Use of Spectroscopic Methods and Their Clinical Applications in Drug Abuse: A Review. Crit Rev Anal Chem 2021; 53:360-373. [PMID: 34376090 DOI: 10.1080/10408347.2021.1958196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Assurance of substance abuse in plasma and different parts of the body is vital in clinical and legal toxicology. Detection techniques are evaluated for their appropriateness in scientific and clinical sciences, where extraordinary prerequisites must be met. Recognition and affirmation are for the most part done by gas chromatography-Mass spectrometry (GC-MS) or liquid chromatography (LC-MS), Surface-enhanced Raman spectroscopy (SERS), Magnetic resonance imaging, Positron Emission Tomography, Infrared Spectroscopy, and UV Spectroscopy. Progressed spectroscopic techniques provided helpful quantitative or qualitative data about the natural chemistry and science of exploited substances. These spectroscopic techniques are assumed as quick, precise, and some of them are non-damaging investigation apparatus that may be assumed as a substitution for previously used compound investigation. Spectroscopy with its advances in technology is centralized to novel applications in the detection of abused drug substances and clinical toxicology. These techniques have attracted growing interest as forensic tools for the early detection and monitoring of exploited drugs. This review describes the principle, role, and clinical application of various spectroscopic techniques which are utilized for the identification of drug abuse like morphine, cocaine, codeine, alcohol, amphetamines, and their metabolites in whole blood, plasma, hair, and nails.
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Affiliation(s)
- Pardeep Kumar
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Aditi Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Lalit Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
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15
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Phillips NS, Duke ES, Schofield HLT, Ullrich NJ. Neurotoxic Effects of Childhood Cancer Therapy and Its Potential Neurocognitive Impact. J Clin Oncol 2021; 39:1752-1765. [PMID: 33886374 DOI: 10.1200/jco.20.02533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Elizabeth S Duke
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC
| | - Hannah-Lise T Schofield
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Nicole J Ullrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
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16
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Meyers SP. Intracranial Abnormalities with Diffusion Restriction. Magn Reson Imaging Clin N Am 2021; 29:137-161. [PMID: 33902900 DOI: 10.1016/j.mric.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple pathologic conditions can cause changes in the random movement of water, which can be detected with diffusion-weighted imaging (DWI). DWI plays a powerful clinical role in detecting restricted diffusion associated with acute brain infarction. Other disorders can also result in restricted diffusion. This article focuses on showing examples of common and uncommon disorders that have restricted diffusion secondary to cytotoxic and/or intramyelinic edema. These disorders include ischemia, infection, noninfectious demyelinating diseases, genetic mutations affecting metabolism, acquired metabolic disorders, toxic or drug exposures, neoplasms and tumorlike lesions, radiation treatment, trauma, and denervation.
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Affiliation(s)
- Steven P Meyers
- Department of Radiology/Imaging Sciences, University of Rochester Medical Center, University Medical Imaging, 4901 Lac de Ville Boulevard, Building D - Suite 140, Rochester, NY 14618, USA.
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17
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Dinicu AI, Chaudhari A, Kayyal S. Diffuse subcortical white matter injury and bilateral basal ganglia neuronal loss after acute opioid overdose. Neuroradiol J 2021; 33:267-270. [PMID: 32508271 DOI: 10.1177/1971400920927878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Opiate intoxication has been associated with life-threatening effects of sympathetic suppression and respiratory depression, but current literature is limited in describing its neurotoxic effects on the central nervous system. Here, we present the case of an otherwise high-functioning adolescent male who was found unresponsive after ingestion of approximately 3-4 fake oxycodone 10-325 mg pills laced with fentanyl. Magnetic resonance imaging showed evidence of diffuse T2 hyperintensities in the corpus callosum and bilateral frontal, parietal, and cerebellum indicative of diffuse white matter injury. In addition, there were distinct areas of restricted diffusion in the bilateral basal ganglia concerning for oxidative stress-mediated neuronal loss. His neurological exam improved with supportive treatment over the course of his hospitalization. Although limited literature has shown leukoencephalopathy to be associated with opioid overdose, we present a case of additional involvement of subcortical gray matter.
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Affiliation(s)
- Andreea I Dinicu
- Department of Neurology, University of California Irvine (UCI), USA
| | - Amit Chaudhari
- Department of Neurology, University of California Irvine (UCI), USA
| | - Simon Kayyal
- Department of Neurology, CHOC Children's Specialists, Orange, USA
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Abstract
Neurotoxicity is a well-documented adverse effect of methotrexate in the treatment of pediatric cancers. The spectrum of symptoms is broad, can include stroke-like episodes and seizures, and classically resolves within days. The majority of patients tolerate subsequent doses without recurrence of symptoms. The population of patients who experience persistent and irreversible neurologic symptoms is poorly described, with the existing literature suggestive of a relationship with radiation therapy. The authors present a case series of 2 patients with pre-B-cell acute lymphoblastic leukemia who developed severe and ultimately fatal methotrexate-related neurotoxicity in the absence of radiation.
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Alungulese AL, Guzmán-de-Villoria Lebiedziejewsi JA, Prieto Montalvo J. Spectrum of neuroimaging findings following drug abuse. Rev Neurol (Paris) 2020; 177:323-325. [PMID: 32747045 DOI: 10.1016/j.neurol.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- A L Alungulese
- Department of Clinical Neurophysiology, Gregorio Marañón University Hospital, Madrid, Spain.
| | | | - J Prieto Montalvo
- Department of Clinical Neurophysiology, Gregorio Marañón University Hospital, Madrid, Spain
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20
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McCarty JL, Leung LY, Peterson RB, Sitton CW, Sarraj A, Riascos RF, Brinjikji W. Ischemic Infarction in Young Adults: A Review for Radiologists. Radiographics 2020; 39:1629-1648. [PMID: 31589580 DOI: 10.1148/rg.2019190033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ischemic strokes in young adults are devastatingly debilitating and increasingly frequent. Stroke remains the leading cause of serious disability in the United States. The consequences of this familiar disease in this atypical age group are especially detrimental and long lasting. Ischemic stroke in young adults is now emerging as a public health issue, one in which radiologists can play a key role. The incidence of ischemic infarction in young adults has risen over the past couple of decades. Increased public awareness, increased use of MRI and angiography, and more accurate diagnosis may in part explain the increased detection of stroke in young adults. The increased prevalence of stroke risk factors in young adults (especially sedentary lifestyle and hypertension) may also contribute. However, compared with older adults, young adults have fewer ischemic infarcts related to the standard cardiovascular risk factors and large- or small-vessel disease. Instead, their infarcts most commonly result from cardioembolic disease and other demonstrated causes (ie, dissection). Thus, radiologists must expand their differential diagnoses to appropriately diagnose ischemic strokes and identify their causes in the young adult population. From the more frequent cardioembolism and dissection to the less common vasculitis, drug-related, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), moyamoya, and hypercoagulable state-related infarcts, this article covers a wide breadth of causes and imaging findings of ischemic stroke in young adults. ©RSNA, 2019.
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Affiliation(s)
- Jennifer L McCarty
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Lester Y Leung
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Ryan B Peterson
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Clark W Sitton
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Amrou Sarraj
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Roy F Riascos
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
| | - Waleed Brinjikji
- From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.)
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Revista Digital Internacional de Psicología y Ciencia Social | Volumen 6 | Número 2 | Julio-Diciembre 2020 | Desafíos contemporáneos en educación y salud. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2020. [DOI: 10.22402/j.rdipycs.unam.6.2.2020.327.245-526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
El actual número se titula “Desafíos contemporáneos en educación y salud” y nos permite conocer acerca de los temas de interés para algunos investigadores y la manera en que se han abordado para su estudio. De manera coincidente este número ha sido trabajado en tiempos de pandemia, donde también nos hemos enfrentado a retos ante las nuevas condiciones para adaptarnos a nuevas formas de trabajo, mayoritariamente a distancia y por ahora a lo que parece ser “la nueva normalidad”, y con ello, en algunos meses, estaremos leyendo trabajos que surjan de estos momentos históricos mundiales, sus implicaciones, problemas, alcances y tal vez sus repercusiones.
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Modelos neuropsicologicos y neuroimagen de las alteraciones cerebrales ocasionadas por la cocaína. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2020. [DOI: 10.22402/j.rdipycs.unam.6.2.2020.243.452-478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La presente revisión de literatura hace referencia a los modelos que la neuropsicología manifiesta en relación a la drogodependencia, con el propósito de explicar el origen y desarrollo de los trastornos adictivos, respaldados por medio de la neuroimagen. El modelo clásico de la adicción, propuesto por Wikel (1965), el cual fue reformulado por nuevos modelos, entre los más destacados, el modelo basado en la transición entre impulsividad y compulsión de Everitt y Robbins (2005), el modelo de alostasis y estrés de Koob y Le Moal (2001, 2008), y el modelo de la sensibilización al incentivo de Robinson y Berridge (2001, 2003, 2008). De manera alternativa surgió el modelo (I-RISA) de Goldstein y Volkow (2002). Al final se formuló el modelo somático de las drogodependencias propuesto por Verdejo-García y Bechara (2009) y Pérez-García y Bechara (2006). Por último se aborda la recuperación o rehabilitación de la adicción desde una perspectiva neurológica y neuropsicológica.
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Singla A, Singh P, Panditrao M, Panditrao MM. Is Chronic Opioid Abuse Associated with Cerebral Atrophy? An Observational Study. Indian J Crit Care Med 2020; 24:276-280. [PMID: 32565639 PMCID: PMC7297238 DOI: 10.5005/jp-journals-10071-23410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Recreational drug abuse is a serious health problem that poses detrimental effects on central nervous system. Neuroimaging plays a pivotal role in the detection of these abnormal changes in the brain associated with the drug abuse. This study focuses on the grading of cerebral atrophy in the opioid-addicted patients and their association with the age and duration of opioid abuse. Objectives Grading of cerebral atrophy in opioid-addicted patients and to assess the probable association between chronic opioid abuse and cerebral atrophy in patients admitted to the intensive care unit (ICU) of a tertiary care hospital. Materials and methods A retrospective study was carried out on 40 patients of opioid abuse who were admitted in the ICU of the hospital over a period of 2 years. Magnetic resonance imaging (MRI) scan of these patients was done using Siemens Avanto 1.5 Tesla scanner. Results All the patients were male with 25 patients having varying degrees of cerebral atrophy as assessed from Pasquier scale. Majority of the patients (n = 14) on chronic opioid abuse had global cortical atrophy (GCA) score of 1 indicative of mild cerebral atrophy. The associated factors like the duration of abuse and age of presentation had significant association with the cerebral atrophic changes in the brain (p < 0.05). Conclusion Opioid-dependent patients with long-term substance abuse had probable association with the atrophic changes in brain as assessed from neuroimaging. The progressing age and longer duration of drug abuse may foster significant alterations to the brain structure leading to varied degree of cerebral atrophy. How to cite this article Singla A, Singh P, Panditrao M, Panditrao MM. Is Chronic Opioid Abuse Associated with Cerebral Atrophy? An Observational Study. Indian J Crit Care Med 2020;24(4):276–280.
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Affiliation(s)
- Ankush Singla
- Department of Anesthesia and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Pushpinder Singh
- Department of Radio Diagnosis, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Mridul Panditrao
- Department of Anesthesia and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Minnu M Panditrao
- Department of Anesthesia and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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Saganuwan SA. Chemistry and Effects of Brainstem Acting Drugs. Cent Nerv Syst Agents Med Chem 2020; 19:180-186. [PMID: 31223094 DOI: 10.2174/1871524919666190620164355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Brain is the most sensitive organ, whereas brainstem is the most important part of Central Nervous System (CNS). It connects the brain and the spinal cord. However, a myriad of drugs and chemicals affects CNS with severe resultant effects on the brainstem. METHODS In view of this, a number of literature were assessed for information on the most sensitive part of brain, drugs and chemicals that act on the brainstem and clinical benefit and risk assessment of such drugs and chemicals. RESULTS Findings have shown that brainstem regulates heartbeat, respiration and because it connects the brain and spinal cord, all the drugs that act on the spinal cord may overall affect the systems controlled by the spinal cord and brain. The message is sent and received by temporal lobe, occipital lobe, frontal lobe, parietal lobe and cerebellum. CONCLUSION Hence, the chemical functional groups of the brainstem and drugs acting on brainstem are complementary, and may produce either stimulation or depression of CNS.
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Affiliation(s)
- Saganuwan Alhaji Saganuwan
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Federal University of Agriculture, P.M.B. 2373, Makurdi, Benue State, Nigeria
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Zirpe K, Bamne SN. Opiate and Cerebral Atrophy. Indian J Crit Care Med 2020; 24:218-219. [PMID: 32565630 PMCID: PMC7297242 DOI: 10.5005/jp-journals-10071-23402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Zirpe K, Bamne SN. Opiate and Cerebral Atrophy. Indian J Crit Care Med 2020;24(4):218-219.
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Affiliation(s)
- Kapil Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
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Nikova AS, Sioutas G, Kotopoulos K, Ganchev D, Chatzipaulou V, Birbilis T. The Clock Is Ticking - Brain Atrophy in Case of Acute Trauma? Korean J Neurotrauma 2019; 15:117-125. [PMID: 31720265 PMCID: PMC6826082 DOI: 10.13004/kjnt.2019.15.e35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Brain atrophy and brain herniation are gaining a lot of attention separately, but a limited amount of studies connected them together, and because of this, we are going to review and examine the subject in the current meta-analysis. Methods The authors collected data reporting brain atrophy of alcoholic and schizophrenic cause, as well as data on control patients, all of which was published on MEDLINE between 1996 and 2018. The included 11 articles were processed with a statistical program. Results We found that the pericerebral space is unequal among the groups, while the intracranial volume is strongly correlated to the biggest foramen of the body. The effect of this inequality, however, is expressed in emergency cases, where the patients with brain atrophy will have more time before the final stage of brain herniation. Conclusion The current study raises a controversial issue that requires careful investigation and high attention from the health care personnel.
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Affiliation(s)
- Alexandrina S Nikova
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Sioutas
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Dimitar Ganchev
- Department of Radiation Oncology, University Hospital "Tsaritsa Yoanna" - ISUL, Sofia, Bulgaria
| | | | - Theodossios Birbilis
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
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Alambyan V, Pace J, Miller B, Cohen ML, Gokhale S, Singh G, Shun MC, Hammond A, Ramos-Estebanez C. The Emerging Role of Inhaled Heroin in the Opioid Epidemic: A Review. JAMA Neurol 2019; 75:1423-1434. [PMID: 29987325 DOI: 10.1001/jamaneurol.2018.1693] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Opioid addiction affects approximately 2.4 million Americans. Nearly 1 million individuals, including a growing subset of 21 000 minors, abuse heroin. Its annual cost within the United States amounts to $51 billion. Inhaled heroin use represents a global phenomenon and is approaching epidemic levels east of the Mississippi River as well as among urban youth. Chasing the dragon (CTD) by heating heroin and inhaling its fumes is particularly concerning, because this method of heroin usage has greater availability, greater ease of administration, and impressive intensity of subjective experience (high) compared with sniffing or snorting, although it also has a safer infectious profile compared with heroin injection. This is relevant owing to peculiar and often catastrophic brain complications. Following the American Medical Association Opioid Task Force mandate, we contribute a description of the pharmacology, pathophysiology, clinical spectrum, neuroimaging, and neuropathology of CTD leukoencephalopathy, as distinct from other heroin abuse modalities. Observations The unique spectrum of CTD-associated health outcomes includes an aggressive toxic leukoencephalopathy with pathognomonic neuropathologic features, along with sporadic instances of movement disorders and hydrocephalus. Clinical CTD severity is predominantly moderate at admission, frequently unmodified at discharge, and largely improved in the long term. Mild cases survive with minor sequelae, while moderate to severe presentations might deteriorate and progress to death. Other methods of heroin use may complicate with stroke, seizure, obstructive hydrocephalus, and (uncharacteristically) leukoencephalopathy. Conclusions and Relevance The distinct pharmacology of CTD correlates with its specific clinical and radiological features and prompts grave concern for potential morbidity and long-term disability costs. Proposed diagnostic criteria and standardized reporting would ameliorate the limitations of CTD literature and facilitate patient selection for a coenzyme Q10 therapeutic trial.
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Affiliation(s)
- Vilakshan Alambyan
- Neurocritical Care and Stroke Division, Department of Neurology, The Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan Pace
- Department of Neurosurgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Miller
- Department of Neurology, University of Minnesota, Minneapolis
| | - Mark L Cohen
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Sankalp Gokhale
- Departments of Neurology and Anesthesiology, Banner University Medical Center, University of Arizona College of Medicine, Tucson
| | - Gagandeep Singh
- Neurocritical Care and Stroke Division, Department of Neurology, The Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Ming-Chieh Shun
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio
| | - Anthony Hammond
- Department of Emergency Medicine, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Ciro Ramos-Estebanez
- Neurocritical Care and Stroke Division, Department of Neurology, The Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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de Oliveira AM, Paulino MV, Vieira APF, McKinney AM, da Rocha AJ, dos Santos GT, Leite CDC, Godoy LFDS, Lucato LT. Imaging Patterns of Toxic and Metabolic Brain Disorders. Radiographics 2019; 39:1672-1695. [DOI: 10.1148/rg.2019190016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Vamadevan T, Howlett D, Filyridou M. Imaging appearances of toxic and acquired metabolic encephalopathic disorders. Br J Hosp Med (Lond) 2019; 80:372-376. [DOI: 10.12968/hmed.2019.80.7.372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most imaging findings relating to toxic and acquired metabolic disorders follow a certain pattern with affinity to a specific topographic area, which can help narrow the differential diagnosis. This is especially useful when the clinical presentation can be variable and there is diagnostic uncertainty. Usually, there is bilateral symmetrical abnormality within the deep grey matter structures and the cerebral cortex because of the high metabolic activity and raised oxygen requirements in these areas. Magnetic resonance imaging, particularly diffusion weighted imaging and fluid-attenuated inversion recovery sequences, is very important in differentiating between various aetiologies in this group. Magnetic resonance imaging can be useful in demonstrating both acute and chronic damage, in evaluating treatment response and in disease prognostication. This pictorial review discusses the computed tomography and magnetic resonance imaging appearances of a spectrum of toxic and metabolic disorders observed in a district general hospital with reference to clinical presentation and imaging features that may allow diagnosis. This includes carbon monoxide poisoning, hypoglycaemia, non-ketotic hyperglycaemia, osmotic demyelination syndrome, posterior reversible encephalopathy syndrome, hypoxic ischaemic encephalopathy, the syndrome of delayed post-hypoxic leukoencephalopathy, hepatic encephalopathy and cocaine toxicity.
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Affiliation(s)
- Tharunniya Vamadevan
- ST4 Radiology Registrar, Department of Clinical Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 1ES
| | - David Howlett
- Consultant Radiologist, Department of Clinical Radiology, Eastbourne District General Hospital, Eastbourne
| | - Maria Filyridou
- Consultant Radiologist, Department of Clinical Radiology, Eastbourne District General Hospital, Eastbourne
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Wong K, Van Tassel DC, Miller JH, Pfeifer CM. Opiate leukoencephalopathy in a pediatric patient. Radiol Case Rep 2019; 14:829-831. [PMID: 31049120 PMCID: PMC6484361 DOI: 10.1016/j.radcr.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/07/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022] Open
Abstract
A 17-year-old male presented from an outside facility in acute respiratory failure and profound hypotension. He was found to have classic MRI brain findings of opiate-induced leukoencephalopathy which was corroborated with urine drug screen and history. This entity has been described in the adults but is not as well recognized in the pediatric population. As the opiate epidemic continues to evolve, this case brings heightened awareness of this disorder to pediatric radiologists.
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Affiliation(s)
- Kevin Wong
- Department of Medical Imaging, Phoenix Children's Hospital, Phoenix, AZ
| | - Dane C Van Tassel
- Department of Radiology, Maricopa Integrated Health System, Phoenix, AZ
| | - Jeffrey H Miller
- Department of Medical Imaging, Phoenix Children's Hospital, Phoenix, AZ
| | - Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
- Corresponding author.
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Goyal P, Malhotra A, Almast J, Sapire J, Gupta S, Mangla M, Mangla R. Neuroimaging of Pediatric Arteriopathies. J Neuroimaging 2019; 29:287-308. [PMID: 30920080 DOI: 10.1111/jon.12614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 01/30/2023] Open
Abstract
Pediatric arteriopathies are increasingly recognized in school-aged children with a variety of presenting symptoms ranging from headache, seizures, encephalopathy, and neuropsychiatric symptoms as well as focal neurologic deficits due to acute ischemic strokes. However, unlike the adult stroke population, there are differences in the clinical manifestations, the stroke mechanism, and risk factors in pediatric ischemic stroke. There has been increasing awareness and recognition of pediatric cerebral arteriopathies as a predominant stroke etiology. Prompt diagnosis of arteriopathies is essential to limit injury and prevent recurrent stroke. Based on predominant vessels involved and clinical symptoms, these arteriopathies can be broadly divided into two categories: large-medium size arteriopathies and small vessel arteriopathies. Each category can be further divided into inflammatory and noninflammatory according to their etiologies. The ability to distinguish between inflammatory and noninflammatory etiologies carries major prognostic implications for acute management and secondary stroke prevention as well as screening for systemic complications and counseling.
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Affiliation(s)
- Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Jeevak Almast
- Department of Radiology, University of Rochester Medical Center, Rochester, NY
| | - Joshua Sapire
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT
| | - Manisha Mangla
- Department of Public Health, SUNY Upstate Medical University, Syracuse, NY
| | - Rajiv Mangla
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY
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Exogenous Toxins and CNS Injuries. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Saigal G, Ezuddin NS, Vega GDL. Neurologic Emergencies in Pediatric Patients Including Accidental and Nonaccidental Trauma. Neuroimaging Clin N Am 2018; 28:453-470. [DOI: 10.1016/j.nic.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kontzialis M, Huisman TAGM. Toxic-Metabolic Neurologic Disorders in Children: A Neuroimaging Review. J Neuroimaging 2018; 28:587-595. [PMID: 30066477 DOI: 10.1111/jon.12551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
There are multiple causes of neurotoxicity in children including medications, extrinsic toxins and insults, illicit drugs, built up of toxic metabolites due to genetic or acquired disorders, and metabolic abnormalities. The review is centered on causes of neurotoxicity affecting the pediatric brain and producing typical and easily recognized imaging manifestations. Early identification of common and less common imaging findings may point toward the correct direction, and may facilitate early diagnosis and institution of appropriate treatment to reverse or at least limit the injury to the developing brain. Two common imaging patterns of neurotoxicity in children are the posterior reversible encephalopathy syndrome and acute toxic leukoencephalopathy that are usually related to chemotherapy and immunosuppression for common pediatric malignancies. Another well-described imaging pattern of injury in children involves reversible splenial lesions with or without associated white matter abnormalities. Multiple additional extrinsic causes of neurotoxicity are presented including radiation and chemoradiation, various medications and treatment regimens, poisoning, illicit drug use or accidental exposure, and the respective characteristic neuroimaging findings are highlighted. Intrinsic neurotoxicity may occur in the setting of inborn errors of metabolism or acquired progressive organ failure leading to build up of toxic metabolites. Additional intrinsic causes of neurotoxicity include metabolic derangements and characteristic imaging findings in all instances are reviewed. The goal of the article is to enhance familiarity of neurologists and neuroradiologists with the imaging appearance of common and less common toxic insults to the pediatric brain.
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Affiliation(s)
- Marinos Kontzialis
- Section of Neuroradiology, Department of Radiology, Rush University Medical Center, Chicago, IL
| | - Thierry A G M Huisman
- Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
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Li S, Manyevitch R, Sedaliu K, Abdelbaki A, Gupta N, Kumar A, Kumar Y, Rosovsky M. Cocaine abuse: Longitudinal MR imaging of lasting diffused leukoencephalopathy. Neuroradiol J 2018; 31:186-189. [PMID: 29400600 DOI: 10.1177/1971400918757090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cocaine use has been known to cause a number of adverse neurological conditions, such as cerebral ischemia and posterior reversible leukoencephalopathy. The radiologic appearance of cocaine-induced leukoencephalopathy is confounded by a common contaminant, levamisole, which is also known to cause multifocal leukoencephalopathy. However, we encountered a case of diffuse leukoencephalopathy in a patient with cocaine use that had extensive involvement of the cerebral white matter, globus pallidi as well as the cerebellum. Our case also presented with a severe clinical presentation, with the patient demonstrating minimal neurologic response after a prolonged period of critical care management. The severe clinical course and diffuse radiologic involvement of our case differs from previously reported cases of cocaine- or levamisole-induced leukoencephalopathy.
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Affiliation(s)
- Shuo Li
- 1 Department of Radiology, Yale New Haven Health 1939 Bridgeport Hospital , USA
| | | | - Kaltrina Sedaliu
- 3 Department of Internal Medicine, Yale New Haven Health 1939 Bridgeport Hospital , USA
| | - Ahmed Abdelbaki
- 1 Department of Radiology, Yale New Haven Health 1939 Bridgeport Hospital , USA
| | | | | | - Yogesh Kumar
- 6 Department of Radiology, Columbia University at Bassett Healthcare, USA
| | - Mark Rosovsky
- 1 Department of Radiology, Yale New Haven Health 1939 Bridgeport Hospital , USA
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Bates DDB, Gallagher K, Yu H, Uyeda J, Murakami AM, Setty BN, Anderson SW, Clement MO. Acute Radiologic Manifestations of America’s Opioid Epidemic. Radiographics 2018; 38:109-123. [DOI: 10.1148/rg.2018170114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David D. B. Bates
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Katherine Gallagher
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - HeiShun Yu
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Jennifer Uyeda
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Akira M. Murakami
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Bindu N. Setty
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Stephan W. Anderson
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Mariza O. Clement
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
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Lincoln CM, Fata P, Sotardi S, Pohlen M, Uribe T, Bello JA. Imaging spectrum of immunomodulating, chemotherapeutic and radiation therapy-related intracranial effects. Br J Radiol 2017; 91:20170553. [PMID: 29039692 DOI: 10.1259/bjr.20170553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A wide range of treatment-related side effects result in specific neurologic symptoms and signs and neuroimaging features. Even to the most seasoned neuroradiologist, elucidating therapy-related side effects from other common mimics can be challenging. We provide a pictorial survey of some common and uncommon medication-induced and therapy-related neuroimaging manifestations, discuss pathophysiology and common pitfalls in imaging and diagnosis. METHODS A case-based review is utilized to depict scenarios on a routine basis in a general radiology or neuroradiology practice such as medication-induced posterior reversible encephalopathy syndrome to the more challenging cases of pseudoprogression and pseudoregression in temozolmide and bevacizumab therapy in gliobastoma treatment protocols. CONCLUSION Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.
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Affiliation(s)
- Christie M Lincoln
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Peter Fata
- 2 Department of Radiology, Houston Methodist , Houston, TX , USA
| | - Susan Sotardi
- 3 Department of Neuroradiology, Massachusetts General Hospital , Boston, MA , USA
| | - Michael Pohlen
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Tomas Uribe
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Jacqueline A Bello
- 4 Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, NY , USA
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Kumar Y, Drumsta D, Mangla M, Gupta N, Hooda K, Almast J, Mangla R. Toxins in Brain! Magnetic Resonance (MR) Imaging of Toxic Leukoencephalopathy - A Pictorial Essay. Pol J Radiol 2017; 82:311-319. [PMID: 28656068 PMCID: PMC5478246 DOI: 10.12659/pjr.901791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Toxic leukoencephalopathy results from damage to the white matter caused by various toxins. It manifests itself as white matter signal abnormalities with or without the presence of restricted diffusion. These changes are often reversible if the insulting agent is removed early, with the exception of posthypoxic leukoencephalopathy that can manifest itself 1–2 weeks after the initial insult. However, many other potential causes of white matter signal abnormalities can mimic the changes of toxic leukoencephalopathy. Thus, familiarity with the causes, clinical presentation and particularly imaging findings of toxic leukoencephalopathy is critical for early treatment and improved prognosis. The purpose of this pictorial essay is to familiarize the reader with the various causes of toxic leukoencephalopathy along with its differential diagnoses and mimics.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, CT, U.S.A
| | - Douglas Drumsta
- Department of Imaging Sciences, University of Rochester Medical Centre, Rochester NY, U.S.A
| | - Manisha Mangla
- State University of New York (SUNY) Upstate Medical University, Syracuse, NY, U.S.A
| | - Nishant Gupta
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, U.S.A
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, CT, U.S.A
| | - Jeevak Almast
- Department of Imaging Sciences, University of Rochester Medical Centre, Rochester NY, U.S.A
| | - Rajiv Mangla
- Department of Radiology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, U.S.A
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Savopoulos C, Kaiafa G, Kanellos I, Fountouki A, Theofanidis D, Hatzitolios AI. Is management of hyperglycaemia in acute phase stroke still a dilemma? J Endocrinol Invest 2017; 40:457-462. [PMID: 27873213 DOI: 10.1007/s40618-016-0584-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/09/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Close monitoring of blood glucose levels during the immediate post-acute stroke phase is of great clinical value, as there is evidence that the risk of neurological deterioration is associated with both hyper- and hypoglycaemia. The aim of this review paper is to summarise the evidence on post-stroke blood glucose management and its impact on clinical outcomes, during the early post-acute stage. FINDINGS Post-stroke hyperglycaemia has been associated with increased cerebral oedema, haemorrhagic transformation, lower likelihood of recanalisation and deteriorating neurological state. Thus, hyperglycaemia during an acute stroke may result in poorer clinical outcomes, infarct progression, poor functional recovery and increased mortality rates. Although hypoglycaemia may also lead to poorer outcomes via further brain injury, it can be readily reversed by glucose administration. In most patients, the goal of regular treatment is euglycaemia and for acute-stroke patients, a reasonable approach is to target control of glucose level at 100-150 mg/dL. CONCLUSION Both hypoglycaemia and hyperglycaemia may lead to further brain injury and clinical deterioration; that is the reason these conditions should be avoided after stroke. Yet, when correcting hyperglycaemia, great care should be taken not to switch the patient into hypoglycaemia, and subsequently aggressive insulin administration treatment should be avoided. Early identification and prompt management of hyperglycaemia, especially in acute ischaemic stroke, is recommended. Although the appropriate level of blood glucose during acute stroke is still debated, a reasonable approach is to keep the patient in a mildly hyperglycaemic state, rather than risking hypoglycaemia, using continuous glucose monitoring.
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Affiliation(s)
- C Savopoulos
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
| | - G Kaiafa
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - I Kanellos
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - A Fountouki
- Blood Donation Department, St Paul Hospital, Thessaloníki, Greece
| | | | - A I Hatzitolios
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
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Montoya-Filardi A, Mazón M. The addicted brain: Imaging neurological complications of recreational drug abuse. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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43
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Abstract
Neuropsychiatric disorders caused by toxic substances pose a great diagnostic challenge due to the large variety of changes caused in the central and peripheral nervous system. The pathogenetic mechanisms at work are multifaceted and partly not solved. In human drug abusers (cannabis, opiates, cocaine, amphetamines, methamphetamine and "designer drugs"), a broad spectrum of central nervous system alterations are observed including infarction, intracerebral and subarachnoidal hemorrhage, hypoxic-ischemic leukoencephalopathy, infections, neuronal loss, specific astroglial and microglial reaction patterns, and vascular changes, including the endothelial cell as well as the basal lamina.
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Affiliation(s)
- Serge Weis
- Division of Neuropathology, Department of Pathology and Neuropathology, Kepler University Hospital and School of Medicine, Johannes Kepler University, Linz, Austria.
| | - Andreas Büttner
- Department of Forensic Medicine, University of Rostock, Rostock, Germany
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44
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El cerebro adicto: imagen de las complicaciones neurológicas por el consumo de drogas. RADIOLOGIA 2017; 59:17-30. [DOI: 10.1016/j.rx.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 11/23/2022]
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Shrot S, Poretti A, Tucker EW, Soares BP, Huisman TA. Acute brain injury following illicit drug abuse in adolescent and young adult patients: spectrum of neuroimaging findings. Neuroradiol J 2017; 30:144-150. [PMID: 28424016 DOI: 10.1177/1971400917691994] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of illicit drugs is currently a major medical problem among adolescents. Several illicit drugs have a high abuse potential and can be neurotoxic causing high morbidity and mortality. The clinical manifestation of adolescents with acute drug-induced neurotoxicity is often characterized by non-specific symptoms and findings. Early diagnosis is important to prevent death and permanent long-term neurological impairments. We report on clinical and neuroimaging findings in five adolescents with acute brain imaging following illicit drug intoxication to highlight the role of neuroimaging findings in the diagnostic work-up of pediatric acute drug-induced neurotoxicity. Our patients reveal two main neuroimaging patterns of brain injury: diffuse symmetric subcortical white matter injury with preferential cerebellar involvement (leukoencephalopathy pattern) or multiple foci of ischemic infarctions in a non-arterial territory distribution (ischemic pattern). Familiarity with these two neuroimaging patterns of findings in the evaluation of magnetic resonance imaging studies in adolescents with acutely altered mental status may suggest the correct diagnosis, narrow the differential diagnosis, and consequently allow early initiation of targeted laboratory investigations and treatment, potentially improving outcome.
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Affiliation(s)
- Shai Shrot
- 1 Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA
| | - Andrea Poretti
- 1 Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA
| | - Elizabeth W Tucker
- 2 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, USA.,3 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins All Children's Hospital, USA
| | - Bruno P Soares
- 1 Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA
| | - Thierry Agm Huisman
- 1 Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA
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Tseng CH, Huang WS, Muo CH, Chang YJ, Sung FC. Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis. J Neurosurg 2015; 123:1528-33. [DOI: 10.3171/2014.11.jns141269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Inflammation may provoke cerebral arteriolar ectasia, inducing microaneurysm formation and further promoting intracerebral hemorrhage (ICH). Chronic osteomyelitis (COM) is an inflammatory disorder for which study of its role in ICH is lacking. This study explored whether COM increases the risk of ICH.
METHODS
From Taiwan national insurance inpatient claims, 22,052 patients who were newly diagnosed with COM between 1997 and 2010 were identified; 88, 207 age and sex frequency-matched subjects without COM were selected at random for comparison. Risks of ICH associated with COM and comorbidities, including hypertension, diabetes, hyperlipidemia, chronic kidney disease, and drug abuse, were assessed by the end of 2010.
RESULTS
The incidence of ICH was 1.68 times higher in the COM cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.50 (95% CI 1.29–1.74) estimated in the multivariable Cox model. Age-specific analysis showed that the HR of ICH for COM patients decreased with age, with an adjusted HR of 3.28 (95% CI 1.88–5.75) in the < 40-year age group, which declined to 1.11 (95% CI 0.88–1.40) in the elderly. The incidence of ICH increased with the severity of COM; for those with severe COM the adjusted HR was 4.42 (95% CI 3.31–5.89). For subjects without comorbidities, the incidence of ICH was 1.20-fold (95% CI 1.00–1.45) higher in the COM cohort than in the comparison cohort.
CONCLUSIONS
This study suggests for the first time that COM is an inflammatory factor associated with increased risk of ICH, especially in younger patients.
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Affiliation(s)
| | | | - Chih-Hsin Muo
- 3Management Office for Health Data, China Medical University Hospital, Taichung
| | - Yen-Jung Chang
- 4Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Fung-Chang Sung
- 5Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung; and
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Wu Y, Huang Q, Liu X, Wei X. Dl-3-n-butylphthalide is effective for demyelination: A case-combined study. Clin Neurol Neurosurg 2015; 137:83-8. [DOI: 10.1016/j.clineuro.2015.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
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Khil EK, Lee AL, Chang KH, Yun TJ, Hong HS. Symmetrical Curvilinear Cytotoxic Edema Along the Surface of the Brain Stem: A Probable New Magnetic Resonance Imaging Finding of Leptomeningeal Carcinomatosis. Medicine (Baltimore) 2015; 94:e1053. [PMID: 26200611 PMCID: PMC4602989 DOI: 10.1097/md.0000000000001053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lung cancer is one of the most common neoplasms to appear leptomeningeal metastasis (LM). Contrast-enhanced magnetic resonance imaging (MRI) is better diagnostic choice for LM and usually shows focal nodular or diffuse linear enhancement on the leptomeninges along the sulci and tentorium in the brain. We experienced atypical 2 cases of lung cancer in patients who showed unusual brain MRI finding of symmetrical curvilinear or band-like, nonenhancing cytotoxic edema along the surface of the brain stem. This finding is unique and different from the general findings of leptomeningeal metastasis. This unique imaging finding of symmetric curvilinear nonenhancing cytotoxic edema along the brainstem is extremely rare and represents a new presentation of leptomeningeal carcinomatosis.
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Affiliation(s)
- Eun Kyung Khil
- From Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyunggi-do, South Korea (EKK, ALL, K-HC, HSH); Department of Radiology, Seoul National University Hospital, Seoul, South Korea (TJY)
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Hansen AL, Dahl L, Olson G, Thornton D, Grung B, Thayer JF. A long-term fatty fish intervention improved executive function in inpatients with antisocial traits and a history of alcohol and drug abuse. Scand J Psychol 2015; 56:467-74. [PMID: 26032440 DOI: 10.1111/sjop.12229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/21/2015] [Indexed: 01/01/2023]
Abstract
The aim of the present study was to investigate the effects of fatty fish consumption on cognitive functioning in a group of inpatients characterized by antisocial behavior. Eighty-three male forensic inpatients participated in this study. Participants were randomly assigned into a Fish or a Control group (e.g., meat, chicken, pork). One decision-making task, the Iowa Gambling Task (IGT), and one planning task, the Tower of Hanoi (ToH), were administered before (pre-test) and at the end of the intervention period (post-test). For the IGT the Fish group showed improved performance from pre- to post- test. Moreover, the Fish group showed significantly better performance than the Control group on the IGT at post-test. The Fish group also demonstrated improved performance from pre- to post-test on the ToH; however, this was limited to participants with a history of substance abuse. Further, the improvement was only significant for tasks with high working memory load (5-7 move problems), and not for tasks with low working memory load (1-4 move problems). The Control group showed no improvement on any of the tasks regardless of alcohol or drug abuse history. The present study suggests that regular fatty fish consumption may improve executive functions in forensic inpatients with antisocial traits and a history of substance abuse. Thus, the current results may have important implications with regard to health care interventions.
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Affiliation(s)
- Anita L Hansen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lisbeth Dahl
- National Institute of Nutrition and Seafood Research (NIFES), Bergen, Norway
| | - Gina Olson
- Sand Ridge Secure Treatment Center (SRSTC), Mauston, WI, USA
| | - David Thornton
- Sand Ridge Secure Treatment Center (SRSTC), Mauston, WI, USA
| | - Bjørn Grung
- Department of Chemistry, University of Bergen, Allégaten 41, 5007, Bergen, Norway
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, OH, USA.,Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Abdel Razek AAK, Alvarez H, Bagg S, Refaat S, Castillo M. Imaging Spectrum of CNS Vasculitis. Radiographics 2014; 34:873-894. [DOI: 10.1148/rg.344135028] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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