Patterns of Brain Injury in Poisoning and Intoxication

Drug abuse and poisoning represent remarkable causes of morbidity and mortality in both developed and developing countries. The most common forms of intoxication vary between different populations and generally include ethanol, drug overdose (e.g. methadone and IV abused opiates, benzodiazepines), recreational drugs (e.g. ecstasy and cocaine) and poisons (e.g. carbon monoxide). Another important challenge is that drug abusers are usually unreliable in terms of presenting history, especially if they had been suicide the existence of suicidal thoughts, psychotic problems or altered mental status. Recreational drugs, ethanol and opioids may all cause coma and loss of consciousness. Therefore, in the acute care setting where clinicians often base treatment on patient history and clinical data, the radiologist may play an important role in drawing a prompt diagnosis. Each types of toxins can cause different patterns of brain injury in acute and delayed states. CT and MRI are valuable in determination of disease extent and may be useful for supposing the causative factor. Due to clinical situation of intoxicated patients, CT and MRI are not part of the usual diagnostic work up of these patients and hence, little imaging is available to preview the findings in acute phase of intoxication. This article contains case series of intoxicated patients who were reviewed for variables such as age, gender, substances ingested or inhaled, imaging findings and clinical outcomes. This manuscript reviews the unusual and interesting neuroradiographic features of carbon monoxide poisoning, opioid and ethanol toxicity, and etc.