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ImagingofDrug relatedChangesintheCentralNervousSystem Multipledrugsofabuse Medicationsormedicaltherapiesthatarepotentiallyneurotoxic NeurovascularcomplicationsEncephalopathyAtrophyInfectionChangesintheCCExtracranialstructuralchangesMiscellaneousCNSeffects NeurovascularComplications Cocaine relatedComplications CocaineisthehallmarkdrugwellknownforproducingbothischemicstrokeandintracranialhemorrhageVasoconstrictionofbloodvessels elevationofbloodpressure tachycardia andincreasedcardiacoutputresultingfromcocainecanleadtodetrimentalacuteneurologiccomplicationsincludingstroke subarachnoidandintraparenchymalhemorrhage aswellasothercomplicationssecondarytochronicabuse Cocaine relatedComplications Cocaine relatedComplications Cocaine relatedComplications Heroin relatedComplications Acuteneurovascularcomplicationssuchasischemiaandstrokeprimarilyoccurinthesettingofintravenousheroinadministrationwithvasospasm vasculitis oremboliceventsIschemiaisthemostcommonlyencounteredacuteneurovascularcomplicationassociatedwithheroinuseAswithcocaine heroincanproducemicrovascularischemicchangesandstroke Heroin relatedComplications Heroin relatedComplications Amphetamine relatedComplications Vasospasmandarteritishavebeendescribedasconsequencesofamphetamineuse aswellasgliosisandneuronallosssecondarytochangesincapillaryvascularbedsSeverecasesofvasculitisofmajorcerebralvesselscanresultindecreasedbrainoxygenationandcatastrophicstroke Amphetamine relatedComplications Encephalopathy Heroin inducedLeukoencephalopathy Heroinisthehallmarkdrugassociatedwithleukoencephalopathy withtheinhaledformcausingaspongiformleukoencephalopathyThekeytodifferentiatingthistypeofleukoencephalopathyfromothermimicsisinvolvementofthecerebellum Heroin inducedLeukoencephalopathy Immunosuppressant relatedComplications Immunosuppressantsareaclassofmedicationswithwell establishedCNScomplicationsTwocategoriesofimmunosuppressants calcineurininhibitorsandmethotrexateEncephalopathyinacuteandreversibleforms aswellasmorechronicpermanentchanges CalcineurinInhibitors relatedComplications Thecharacteristicneurotoxicprocessoftenassociatedwithcalcineurininhibitorsisposteriorreversibleencephalopathysyndrome PRES Directeffectsonvascularendothelialcellsresultinginreleaseofmultiplefactorsthatcausevasoconstrictionofthecerebralvessels leadingtoimpairedcerebralbloodflowandreversibleischemia whichmanifestasvasogenicedema CalcineurinInhibitors relatedComplications Methotrexate relatedComplications Inthebrain thepathophysiologyofmethotrexateprimarilyinvolvesreversiblecytotoxicedemainhemisphericwhitemattermanifestingclinicallyasaleukoencephalopathyAtimaging acuteleukonecephalopathysecondarytomethotrexateappearsaspersistentortransientdiffusehighsignalintensityinthewhitematteronT2 weightedandFLAIRimages Methotrexate relatedComplications Cocaine relatedComplications CocainecanalsoresultinPRESviaalterationsinbloodpressure Alcohol relatedComplications Thepathophysiologyofalcoholabuseincludesbothdirecteffectsonthebrainaswellassecondarycomplicationsarisingfromcirrhosisandnutritionaldeficiency Wernickeencephalopathy NeuropathologicabnormalitiesofWernickeencephalopathyincludelesionsintheperiventricularnuclei hypothalamicnuclei andthalamus allofwhicharesecondarytothiamine vitaminB1 deficiency Alcohol relatedComplications Atrophy ComplicationsRelatedtoDrugsofAbuse Drugsofabuseincludingcocaine heroin andalcoholarecollectivelyoneoftheleadingcausesofbrainatrophyCerebellaratrophyisawell knowncomplicationofalcoholismChronicconsequencesofcocaineabuseincludeparenchymalatrophyaswellasscatteredfociofhighsignalintensityonT2 weightedimages Alcohol relatedcerebellaratrophy Chronicchangessecondarytococaineabuse ComplicationsRelatedtoAntiepilepticDrugs Bothcerebellaratrophyandhyperostosisoftheskullcanbeseenwithphenytoinuse Infection InfectionRelatedtoDrugsofAbuse Intravenousadministrationofheroincanpotentiallycauseendocarditis septicemboli withStaphylococcusaureusbeingthemostcommonisolatedorganismTheadverseeffectsofHIVontheunderlyingmetabolismofthebrainwereaugmentedbychronicalcoholabuse eventuallycausingparenchymalloss moreprominentinthewhitematter ChangesintheCorpusCallosum ChangesintheCorpusCallosum Marchiafava Bignamidisease MBD isararealcohol associateddisordercharacterizedbydemyelinationandnecrosisofthecorpuscallosumA majorimpairmentofconsciousness poorclinicaloutcome moreextensiveandincludediffuseedemaoftheentirecorpuscallosumB slightimpairmentofconsciousness favorableclinicaloutcome partialinvolvementofthecorpuscallosum Alcohol relatedMBD ChangesintheCorpusCallosum ACNSabnormalityrecentlyassociatedwithanticonvulsanttherapyisfocalsignalintensityalterationinthecorpuscallosum specificallyinvolvingthesplenium ExtracranialStructuralChanges Chronicconsequencesofcocaineabuseincludenasalmucosalchanges specificallyviatheintranasalrouteofadministration MiscellaneousCNSEffects MiscellaneousCNSEffects NitrousoxideisaninhaledanestheticcommonlyusedindentistryNitrousoxideproducestheneurotoxiceffectsoftheanesthetic preventingthenecessarychainofmethylationofmyelinsheathphospholipidsandmyelinformationSubacutecombineddegenerationofthespinalcord increasedsignalintensityintheposteriorcolumnsofthespinalcord Subacutecombineddegenerationofthespinalcord TPN relatedchanges Patientsreceivinglong termTPNcandevelopparkinsonian typesyndromessecondarytodopaminedepletion Thepathophysiologyissecondarytodepositionofthetraceelemen
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