Download Brain structural -haemodinamic changes caused by

Brain structural -haemodinamic changes caused by
Methcathinone (Ephedron) abuse.
Poster #: EP-37
Research Institute of Clinical Medicine
Tbilisi, Georgia
D. Gachechiladze, , F. Todua, M.Okujava , D. Miminoshvili
Poster #: EP-37
Title: Methcathinone (Ephedron) abuse- Brain structural -haemodinamic
changes
Disclosure Statement:
No disclosures
 Toxic encephalopathy, also known as toxic-metabolic
encephalopathy, is a degenerative neurologic disorder
caused by administration of toxic substances, that can be
presented with different neurological abnormalities.
15%
85%
Encephalopathy
Toxic encephalopathy
PURPOSE:
 The aim of our study was to assess the
neuroradiologic and haemodinamic findings in
patients using synthetic (self-made) manganese
based psychoactive substances (Methcathinone).
Psychoactive substance
Ephedrone
-
derived via the oxidation of Ephedrine
(pseudoephedrine) + potassium permanganate + acetyl salicylic
acid (aspirin)
Street names – “Cat”, “Jeff”, “Speed”, “Russian Cocktail”
Materials and Methods:M
2007-2013 years were investigated 41 patients (35 male and 6 female) with
chronic intravenous use of manganese based drugs.
Patients age ranged from 23 to 54 years
The duration of the substance abuse
ranged from 7 month to 7 years.
Materials and methods
Collor Doppler of extra-intracranial vessels
Toshiba Aplio 500, AplioXG
MRT, MRA- Siemens Magnetom Avanto (1.5T), Magnetom Aera (1.5T),
Siemens Magnetom Verio (3T)
T1(se)-TR -570 ms, T1(fl) - TR -31 ms, T2(se)-TR -6000 ms, TE-118ms
– pulse sequences
2 cases- MSCT / CTA- Siemens Somatom Definition Edge(384sl)
Toshiba Aquilion One 640sl.



Toxic encephalopathy is attributed to manganese induced oxidative stress.
High concentration of the proteins transform the Mn2+ into Mn3+, which is
highly toxic and inhibites mitochondrial activity.
Mn accumulation depletes dopaminergic systems and causes some neurological
symptoms.








Euphoria
Hyperactivity (mostly without any reason)
Logorrhea
(mostly without any meaning)
Increase libido
Impulsiveness
Tachicardia
Parestesis
after 4-6 hours Headache, Apathy, Depression
Memory impairment (verbal and non-verbal.
Irrational thinking.
Personality changes :Aggressive ,Obsessive, Destructive
Substance abuse with the duration of more than 6 months
was associated with stabile neurological disabilities.
Most patients had the combination of extrapyramid disorders
(parkinsonism, muscular dystonia, tremor, myoclonia) with
mild cognitive abnormalities (bradyphrenia, attenuated
attention, reduced working capacity, decreased phonetc
verbal fluency, tendency to impulsivness).
Parkinsonian syndrome (Manganism)
Bradykinesia
Oligokinesia
Bradymimia (mask-like face)
Tremor
Dystonia of the lower extremities
Retro and Anteropulse
Medications used for treatment of Parkinson’s disease are less
effective.
“Cock-walk” gait
“Cock-walk”gait
in
which
patients walk on their toes, feet
not comletely contacting with
the ground.
(there is tendency to fall while
walking backwards).
Abnormalities were revealed in 35 (85%) cases

Characteristic lesions are revealed on MR T1-weighted images.

Hyperintense signals detect on the different structures of brain, most common on the
level of globus pallidum.
80%
60%
75%
69%
56%
40%
20%
0%
15%
9%
The MRI signal abnormalities e caused by the accumulation of manganese.
The signal intensity was higher after recent and frequent use of the drug, but changes
were not associated with the clinical pictures.
T1-weighted Hyperintense signals
In cases of the termination of the substance use, pathologic signal in
basal ganglia disappeared after 6-8 months, but clinical signs
remained unchanged.
41y. Old male. Abuse 2.5y. Stroke. Thrombosis of left MCA-M2
MDCTA
TCCD
CTP
27Y. Male. Abuse 3y. Spontaneous dissection of the left ICA.
Tof-fl-2d-MIP
Same patient
TCCD
T2 tirm tra dark-f
ep 2d diff orth p2
Mean, sistolic and diastolic flow for abusers (A) and control (C) subjects.
120
100
80
A-MCA
C-MCA
A-MCA
C-ACA
60
40
20
0
V sis
V mean
V dia
Vessel irregularity ( vasoconstrictiom / vasodilatation) – 28 (67%) cases;
Tof-fl-3d-MIP
Pulsation indexes (PI) for abusers and control
subjects
1
0,8
0,6
Abuse
Control
0,4
0,2
0
MCA
ACA
BHI (%)= (MFVap-MFVrest)x 100 /MFVrest
x30
 Abuse Women 0.87± 0.53
 Abuse Men
0.72± 0.41
 Healthy
0.97± 0.44
CONCLUSION
Our results suggests, that MRI demonstrate systematic
brain structural changes in Methcathinone abusers.
Slowed cerebral blood flow velocity with increased
pulsatility and impaired CRV in abusers indicate
increased
cerebrovascular
resistance
due
to
vasoconstriction of small cortical vessels.
Neurovisualisation play important role in detection and
differentiation of brain abnormalities in patients with
drug abuse history and therefore in selection of
adequate treatment tactics.
Thank you for attention