ARRS 2022 Abstracts


E1794. Drugs: Used, Abused, and Confused - Imaging Review of CNS Pathologies Associated with Recreational Drug Use
  1. Jonathan Mackow; Stony Brook University Hospital
  2. Katherine Chung; Stony Brook University Hospital
  3. Jolanta Norelli; Stony Brook University Hospital
  4. Patricia Roche; Stony Brook University Hospital
Drug abuse is a commonly seen cause of hospital admission nationwide. Many of these drugs, including ethanol, heroin, cocaine, and amphetamines are neurotoxins that directly target the CNS leading to significant morbidity and mortality. Additionally, clinicians must be aware of the medication, therapies, and chemical exposures that could present with their own specific imaging findings and symptom presentations. Altogether, abused drugs, prescribed medications, and inhalation chemicals can cause significant CNS complications, ranging from encephalopathies to neurovascular accidents, as well as brain atrophy, infections, and hemorrhage.

Educational Goals / Teaching Points
In this exhibit, an illustration of common and uncommon brain pathologies are presented to guide radiologists when formulating a differential diagnosis for patients with altered mental status in setting of recreational drug use. We will review common drugs and chemicals responsible for CNS neurotoxicity and provide an overview of their clinical features, pathophysiology, imaging findings, complications, and treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this educational exhibit, we will review spectrum of multimodality imaging findings related to recreational drug use through a systematic case-based review. We will present a case of heroin inhalational use with the classic "chasing the dragon" in toxic leukoencephalopathy; embolic ischemic stroke with hemorrhagic conversion in a patient with history of IVDU and endocarditis; carbon monoxide brain injury; Wernicke encephalopathy in patient with chronic alcohol use; hypoxic ischemic encephalopathy in setting of polysubstance use; and others. Lastly, iatrogenic causes of CNS toxicity will be briefly discussed, such as chemotherapy induced encephalopathy.

Radiologists should be familiar with these disease entities because a delay in diagnosis and treatment could cause fatal or permanent injuries to the brain. A high suspicion for these diagnoses should always be kept in the differentials, especially in high-risk populations.