Purpose: The use of illicit drugs is currently a major medical problem among adolescents. The clinical manifestation of adolescents with acute drug-induced neurotoxicity is often characterized by nonspecific symptoms and findings. We report on clinical and neuroimaging findings in 7 adolescents with acute brain imaging following illicit drug intoxication.
Materials and Methods: Clinical data and results of laboratory investigations were collected from review of the clinical history. All imaging studies were evaluated retrospectively for supra- and infra-tentorial abnormalities.
Results: All patients presented with acute altered mental status, 1 patient had seizures, 1 patient showed extrapyramidal signs and 1 patient had spinal cord related symptoms. Opiates were the most common substance. Neuroimaging findings included symmetric subcortical white matter involvement in all patients, multiple foci of acute ischemic infarctions in 1, and both patterns of brain injury in 1. Four patients had cerebellar involvement including diffuse symmetrical cerebellar edema in 3 patients and multiple foci of cerebellar ischemic infarctions in 1. In 4 patients, there was involvement of the basal ganglia, either as diffuse edema or multiple foci of acute ischemic infarctions. The thalami and cerebral cortex were spared in all patients. When diffusion-weighted imaging was obtained, white matter T2 edema also showed restricted diffusion, both in infra- and supratentorial white matter.
Conclusions: Our patients reveal 2 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 nonarterial territory distribution (ischemic pattern). Familiarity with these 2 neuroimaging patterns of findings in the evaluation of MRI studies in adolescents with acutely altered mental status, may suggest the correct diagnosis and narrow the differential diagnosis.
