Cerebral abnormalities in cocaine abusers: demonstration by SPECT perfusion brain scintigraphy. Work in progress.

Abstract

Single photon emission computed tomography (SPECT) perfusion brain scans with iodine-123 isopropyl iodoamphetamine (IMP) were obtained in 12 subjects who acknowledged using cocaine on a sporadic to a daily basis. The route of cocaine administration varied from nasal to intravenous. Concurrent abuse of other drugs was also reported. None of the patients were positive for human immunodeficiency virus. Brain scans demonstrated focal defects in 11 subjects, including seven who were asymptomatic, and no abnormality in one. Among the findings were scattered focal cortical deficits, which were seen in several patients and which ranged in severity from small and few to multiple and large, with a special predilection for the frontal and temporal lobes. No perfusion deficits were seen on I-123 SPECT images in five healthy volunteers. Focal alterations in cerebral perfusion are seen commonly in asymptomatic drug users, and these focal deficits are readily depicted by I-123 IMP SPECT.

Increased CSF Volumes Are Associated with Diminished Subjective Responses to Cocaine Infusion

“…Thus, the data replicate previous associations between anatomic brain measures and brain function, as assessed by its pharmacologic response to cocaine infusion (Morgan et al 1993). The existence of such an association is supported by functional imaging studies, which have demonstrated changes in the frontal lobe of cocaine addicts (Volkow et al 1992, Tumeh et al 1990, Strickland et al 1993). These functional changes may have structural underpinnings consisting of reduced frontal lobe gray matter (Liu et al 1998;Pfefferbaum et al 1998) and lower dopamine levels and dopamine transporter receptors in the frontal cortex (Hitri et al 1994;Little et al 1996).…”

Demonstration of Dose-Dependent Global and Regional Cocaine-Induced Reductions in Brain Blood Flow Using a Novel Approach to Quantitative Single Photon Emission Computerized Tomography

“…Localization of brain blood flow (BBF) abnormalities in cocaine users during drug taking is, however, not well characterized (Tumeh et al 1990;London et al 1990a,b;Woods et al 1991;Lamki et al 1993) but can be severe (Jensen et al 1990;Woods et al 1991;Holman et al 1992). The distribution of abnormalities in perfusion vary according to whether the patient is on the drug at the time of imaging, recently withdrawn, or detoxicated for a long time (Holman et al 1991;Strickland et al 1991;Fowler et al 1993;Weber et al 1993;Volkow et al 1996).…”

Methadone Treatment Induces Attenuation of Cerebrovascular Deficits Associated with the Prolonged Abuse of Cocaine and Heroin

“…The present study reported increased cerebral resistance in methadonemaintained polysubstance abusers and nontreatment seeking polysubstance abusers who recently used both cocaine and heroin. Several groups of investigators have reported reduced flow or metabolism in cocaine abusers (Tumeh et al, 1990;Weber et al, 1990;Volkow et al, 1991;Holman et al, 1991;Levin et al, 1994Levin et al, , 1995Herning et al, 1999). Moreover, increased flow resistance, using TCD, has been found to persist even after a month of monitored abstinence (Herning et al, 1999).…”

“…Individuals who abuse both heroin and cocaine might also show reductions in cerebral perfusion secondary to their prolonged use of cocaine. For example, several investigators using position emission tomography (PET) and SPECT (Tumeh et al, 1990;Weber et al, 1990;Volkow et al, 1991;Holman et al, 1991;Levin et al, 1994Levin et al, , 1995 as well as transcranial Doppler sonography (TCD) (Herning et al, 1999) have reported reduced perfusion in cocaine abusers. Thus, cocaine and heroin may potentiate each other's influence on cerebral blood flow.…”