Neuroradiology and Drug Abuse: A Picture Is Worth a Thousand Words

Andrei I. Holodny

Drug abuse continues to be the scourge of the modern world, affecting the destitute and underprivileged, as well as the most affluent in all countries. In the current issue of the AJNR, Aydin et al (page 1173) describe and catalogue the neuroradiologic findings of a form of drug abuse, chronic toluene inhalation, as depicted on MR images.

In this article, the authors document abnormalities in the white matter tracts and in the thalami of chronic toluene abusers and detail the concordance of the MR findings with the results of the neurologic examination. In the study population, in which the average patient age was 17.5 years, the neurologic signs and symptoms included insomnia and forgetfulness in 83%, tremors in 54%, ataxia and disturbed cerebellar test performance in 49%, rigidity in 24%, and dysarthria in 10%. The authors also found that the severity of the white matter disease is correlated with the duration of abuse. In addition, the following neuroradiologic findings were seen on the MR images: 1) hyperintensities in the cerebellum, brain stem, and upper cervical cord at T2-weighted imaging; 2) generalized atrophy of the brain; 3) thinning of the corpus callosum; and 4) abnormalities in the substantia nigra, the red nucleus, and the hippocampus. MR findings of severe abnormalities in what should be pristine adolescent brains are truly disturbing. It is also important to remember that this type of drug abuse is certainly prevalent in the United States and Europe. This sobering thought may spur some of us on to fulfill our social responsibilities.

I certainly hope that, when each of us writes or reads a scientific paper, we strive to accomplish more than just describe a disease process. Our work should offer concrete benefit for human beings. As neuroradiologists, what can we do to combat drug abuse? Clearly, images can serve as a powerful deterrent. For example, I remember being in grade school, when images from an anti-smoking campaign showed the difference between healthy lungs and smokers’ lungs.

However, perhaps the strongest testament to the power of a radiologic image is conveyed by the noted cardiologist and Nobel Prize winner Evgeni Chazov (1). He describes the situation in communist Mongolia in 1984 when the country was ruled by the aging Yumjaagiyn Tsedenbal, who according to Chazov, lost his mental faculties and left all decision making to his rude power-hungry wife. Removing the leader was not all that easy, and the members of the government were reluctant to move against Tsedenbal, although they understood his limited mental capacity. His ouster was facilitated by sending Tsedenbal for a health check-up that included CT of the brain. Needless to say, the images showed severe atrophy. Chazov showed the CT scan, along with a CT scan of normal brain for comparison, to the members of the Mongolian politburo. After seeing the severe atrophy of Comrade Tsedenbal’s brain, they quickly deposed him.

All neuroradiologists know that cerebral atrophy does not necessarily connote dementia. Also, I do not know whether the change in governmental leadership has improved the welfare of the Mongolian people. Nevertheless, the fact remains that a single neuroradiologic image is powerful enough to bring about a change in the leadership of a communist country.

I am far from advocating the platonic aphorism that we make mistakes only because of ignorance. Clearly, neuroradiology cannot conquer the problem of drug abuse. MR images cannot solve life’s challenges (eg, homelessness, stark poverty, orphanhood) that perhaps led the child and adolescent subjects of the current study to turn to drugs. Nevertheless, the episode described earlier demonstrates how powerful a single neuroradiologic image can be. We can only hope that work such as the current article that demonstrates the damage inflicted on young brains by drug abuse can be used to influence young minds. Perhaps showing a 14-year-old youth that his brain will look like that of an 85-year-old man may convince him not to start sniffing glue.