Synthetic drugs contain substances that are pharmacologically similar to those found in traditional illicit drugs. Some of the most commonly abused synthetic drugs include synthetic marijuana, bath salts, ecstasy, N-bomb, methamphetamine and anabolic steroids. Many of them share the same chemical properties and physiologic responses with the drugs they mimic and may exaggerate the pathologic response in the brain leading to addiction. These drugs have detrimental (and often irreversible) effects on the brain and primarily affect the central nervous system by two mechanisms: 1) Neural hyper stimulation via increasing activation of certain neurotransmitters (norepinephrine, dopamine, and serotonin), 2) Cause significant reduction in CNS neural connectivity affecting various brain regions such as the basal ganglia, hippocampus, cerebellum, parietal lobe, and globus pallidus. Furthermore these drugs sometimes have severe, lifethreatening adverse effects on the human body. A few structural MRI studies have been conducted in synthetic drug abusers to reveal the effects of these drugs on the brain parenchyma. This review article will describe the potential brain imaging findings in synthetic drug abusers as demonstrated by several case reports and the primary literature.
Carotid artery stenosis accounts for approximately 10% of ischemic strokes. Improved methods of diagnosis of cerebrovascular atherosclerosis would result in significant improvement in quality of life and major savings in health care costs. Imaging plays a critical role evaluating patients suspected of acute stroke. Magnetic Resonance Imaging (MRI's) significant advantages over DUS in carotids imaging can pay off its cost by means of improved patient outcome. Although DUS is frequently performed to evaluate carotid disease, there is nonuniformity in practice among laboratories. MRI can detect and quantify major compositional features of the carotid plaque and comprehensively evaluate its complications. A high level of agreement exists between high-resolution in vivo MRI, gross, and histological findings on the thickness and sites of potential rupture of the fibrous cap in advanced carotid artery atherosclerosis. MRI is capable of classifying and distinguishing different stages of atherosclerotic lesions. It can also examine the mechanisms of regression, progression, and endothelial dysfunction of the carotid plaque. Carotid MRI is a histologically validated, non-invasive imaging method that can track atherosclerotic disease progression and regression. It can quantitatively evaluate parameters associated with plaque morphology and composition. MRI is able to quantify high-grade carotid artery stenosis and occlusion with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. The aim of this article is to examine the efficacy of MRI versus DUS in identifying vulnerable carotid lesions in the acute stroke patient that can account for stroke etiology or mechanism.
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